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The purpose of this study was to explore the usefulness of the Personality Assessment Inventory (PAI; Morey, 1991) Borderline full scale (BOR) and subscales in the assessment of patients being evaluated for dialectical behavior therapy... more
The purpose of this study was to explore the usefulness of the Personality Assessment Inventory (PAI; Morey, 1991) Borderline full scale (BOR) and subscales in the assessment of patients being evaluated for dialectical behavior therapy (DBT; Linehan, 1993). We administered 67 patients both the PAI and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Structured Clinical Interview for Axis II disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1997). Point biserial correlations showed a significant relationship between the presence of borderline personality disorder (BPD) and scores on the BOR and Schizophrenia (SCZ) scales. A regression analysis showed that among the BOR subscales, those measuring identity disturbance, self-harming behavior, and negative relationships were significantly related to the total number of SCID-II BPD criteria. Diagnostic efficiency statistics between the BOR scale and the number of SCID-II BPD criteria indicated that a T score cutoff of 65 optimally differentiates patients who do and do not meet criteria for BPD. The relationship between BOR and SCID-II BPD demonstrates the concurrent validity of the PAI and shows its usefulness in this setting.
Research Interests: Psychology, Clinical Psychology, Personality, Personality Assessment, Borderline Personality Disorder, and 15 moreMedicine, Humans, Behavior Therapy, United States, Female, Male, Regression Analysis, Mental Disorder, Questionnaires, Adult, Dialectical Behavior Therapy, Concurrent Validity, American Psychiatric Association, Psychology and Cognitive Sciences, and Diagnostic and Statistical Manual
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Background. Little is known about how continuation and maintenance cognitive-behavioural therapy (CBT) influences important psychological constructs that may be associated with long-term outcome of major depressive disorder. The goal of... more
Background. Little is known about how continuation and maintenance cognitive-behavioural therapy (CBT) influences important psychological constructs that may be associated with long-term outcome of major depressive disorder. The goal of this study was to examine whether CBT would help maintain attributional style changes experienced by patients during acute phase fluoxetine treatment.Method. Three hundred and ninety-one patients with major depressive disorder were enrolled in an open, fixed-dose 8 week fluoxetine trial. Remitters to this acute phase treatment (N=132) were randomized to receive either fixed-dose fluoxetine (meds only) or fixed-dose fluoxetine plus cognitive-behavioural therapy (CBT+meds) during a 6-month continuation treatment phase. The Attributional Style Questionnaire (ASQ) was completed by patients at three time points – acute phase baseline, continuation phase baseline and continuation phase endpoint. Analysis of covariance was used to compare continuation phase ASQ composite score changes between groups.Results. Patients in both treatment groups experienced significant gains in positive attributional style during the acute phase of treatment. Continuation phase ASQ composite change scores differed significantly between treatment groups, with the CBT+meds group maintaining acute phase positive attributional style changes, and the meds only group exhibiting a worsening of attributional style. The two treatment groups did not significantly differ in rates of relapse and final continuation phase visit HAMD-17 scores.Conclusions. In this sample, the addition of CBT to continuation psychopharmacological treatment was associated with maintenance of acute treatment phase attributional style gains. Further research is needed to evaluate the role of such gains in the long-term course of depressive illness.
Research Interests: Psychology, Cognition, Treatment Outcome, Medicine, Psychological Medicine, and 15 moreHumans, Psychological, Female, Cognitive Behaviour Therapy, Cognitive Therapy, Male, Middle Aged, Adult, Randomized Controlled Trial, FLUOXETINE, Continuation, Neurosciences, SECONDARY PREVENTION, Serotonin Uptake Inhibitors, and Psychiatric Status Rating Scales
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This chapter provides a summary of borderline personality disorder (BPD) and dialectical behavior therapy (DBT). Diagnostic criteria, prevalence, and the biosocial theory of BPD are reviewed. DBT provides a clear structure for the... more
This chapter provides a summary of borderline personality disorder (BPD) and dialectical behavior therapy (DBT). Diagnostic criteria, prevalence, and the biosocial theory of BPD are reviewed. DBT provides a clear structure for the treatment of BPD using individual psychotherapy, group skills training, and telephone coaching. An overview of the treatment is provided, with particular attention to constructs added to standard CBT such as dialectics, validation, mindfulness, skills training, and the importance of consultation. This chapter also provides a case example to illustrate key aspects of DBT.
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Research Interests: Psychology, Consulting, Medicine, Humans, Major Depressive Disorder, and 14 moreChronic Disease, Female, Cognitive Therapy, Male, Cognitive behavior therapy, Recurrence, Questionnaires, Adult, Time Factors, FLUOXETINE, Serotonin Uptake Inhibitors, Severity of Illness Index, Acute Disease, and acute phase
Women are at particular risk for Posttraumatic Stress Disorder (PTSD), but surprisingly little is known about their objective manifestations of the disorder's hallmark symptoms. Although research suggests that people with PTSD... more
Women are at particular risk for Posttraumatic Stress Disorder (PTSD), but surprisingly little is known about their objective manifestations of the disorder's hallmark symptoms. Although research suggests that people with PTSD exhibit physiological reactivity to the presentation of trauma-related cues, the majority of studies to date have focused on men. We assessed the physiological reactions of three groups of trauma-exposed female Vietnam veterans (those with current PTSD, lifetime PTSD, or no PTSD) to war-related stimuli. Responses of women with current PTSD differed significantly from those without PTSD on skin conductance and systolic blood pressure, and mean levels of reactivity for women with lifetime PTSD fell between the other two groups. Although symptom severity was correlated with physiologic reactivity overall, results suggested differential relationships at the symptom cluster level. Study results replicate earlier findings with men and extend knowledge of autonomic reactivity to an important group of female survivors.
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Autonomic Nervous System, Humans, and 15 moreBlood Pressure, Galvanic Skin Response, Chronic Disease, United States, Female, Clinical, Male, Veterans, Heart rate, Middle Aged, Adult, Analysis of Variance, Case Control Studies, Severity of Illness Index, and Psychiatric Status Rating Scales
Research Interests: Clinical Psychology, Depression, Emotion Regulation, Group Psychotherapy, Medicine, and 15 moreEmotions, Humans, Behaviour, Business and Management, Major Depressive Disorder, Behavior Therapy, Female, Male, Autoregulation, Adult, Dialectical Behavior Therapy, Depressive Symptoms, Pilot Projects, Control Group, and Behaviour Therapy
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BACKGROUND The purpose of this study was to examine whether treatment response to fluoxetine by depressed outpatients was predicted by early improvement on any of 3 subscales (Anxiety, Depression, and Anger/Hostility) of the Symptom... more
BACKGROUND The purpose of this study was to examine whether treatment response to fluoxetine by depressed outpatients was predicted by early improvement on any of 3 subscales (Anxiety, Depression, and Anger/Hostility) of the Symptom Questionnaire (SQ). METHODS We evaluated 169 depressed outpatients (52.6% female) between ages 18 and 65 (mean age, 40.3 +/- 10.6 years) meeting DSM-IIIR criteria for major depressive disorder (MDD). All patients completed the SQ at baseline (week 0) and at weeks 2, 4, and 8 of treatment with fluoxetine 20 mg/d. We defined treatment response as a > or= 50% reduction in score on the 17-item Hamilton Rating Scale for Depression, and early improvement on 3 SQ subscales (Anxiety, Depression, and Anger/Hostility) as a >30% reduction in score by week 2. RESULTS The percentage of patients with significant early improvement in anger was significantly greater than the percentage of those with early improvements in anxiety or depression. When early improveme...
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... R. Baity a , Mark A. Blais a & Michelle C. Jacobo a pages 351-358. ... Archives of General Psychiatry , 48: 10601064. [PubMed], [Web of Science ®] View all references; Linehan et al., 199916. Linehan, MM, Schmidt,... more
... R. Baity a , Mark A. Blais a & Michelle C. Jacobo a pages 351-358. ... Archives of General Psychiatry , 48: 10601064. [PubMed], [Web of Science ®] View all references; Linehan et al., 199916. Linehan, MM, Schmidt, H., Dimeff, LA, Craft, JC, Kanter, J. and Comtois, KA 1999. ...
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Very little research has examined the frequency with which women with major depressive disorder experience premenstrual exacerbation (PME) of depression or the characteristics of those who report such worsening. The NIMH Sequenced... more
Very little research has examined the frequency with which women with major depressive disorder experience premenstrual exacerbation (PME) of depression or the characteristics of those who report such worsening. The NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study provides a unique opportunity to evaluate PME in depressed women seeking treatment in primary care or psychiatric settings. This report presents data from the first 1500 participants enrolled in the STAR*D study. Premenopausal women with major depressive disorder were asked if they experienced a worsening of their depressive symptoms 5-10 days prior to menses. Those reporting PME were compared with those reporting no PME with regard to sociodemographic characteristics, course of illness features, symptom presentation, general medical co-morbidity, functional impairment, and quality of life. Of 433 premenopausal women not taking oral contraceptives, 64% reported a premenstrual worsening of their de...
Research Interests: Psychology, Primary Care, Quality of life, Adolescent, Psychological Medicine, and 16 morePremenstrual Syndrome, Humans, Major Depressive Disorder, Psychological, Female, Self Disclosure, Functional impairment, Aged, Middle Aged, Premenopausal women, Major Depression, Adult, Public health systems and services research, Depressive Symptoms, Neurosciences, and Oral Contraceptive
Genetic and environmental factors influence drug abuse, but abuse represents the culmination of a sequence of events. Different levels of use may have different determinants and these determinants may differ across drug types.... more
Genetic and environmental factors influence drug abuse, but abuse represents the culmination of a sequence of events. Different levels of use may have different determinants and these determinants may differ across drug types. Approximately 3200 male-male twin pairs from the Vietnam Era Twin Registry were interviewed by telephone. Data were obtained regarding exposure to six categories of illicit drugs, initiation of use, continuation of use, regular usage, and diagnosis of drug abuse/dependence. Genetic, common environmental, and unique environmental influences on transitions of drug involvement, defined as movement from one level of drug use to the next, were investigated. Marijuana had the highest conditional probability for the transition from exposure to use, from use to use more than five times, and from use more than five times to regular use. The rate of transition to regular use of heroin was higher than the rate for amphetamine, cocaine, sedatives, and psychedelics. Cocain...
Research Interests: Genetics, Psychology, Cognitive Science, Depression, Child Development, and 32 moreStatistical Analysis, Behavior Genetics, Risk, Psychopathology, Vietnam, Adolescent, Emotions, Drug Use, Humans, Child, Models, Correlation, Female, Male, Veterans, Developmental Stages, Conduct Disorder, Social Environment, Risk factors, Conditional probability, Drug abuse, Clinical Sciences, Middle Aged, Adult, Illicit Drugs, Street Drugs, Twin Study, Risk Factors, Parent‐child Relations, Neurosciences, Drug Dependence, and Substance-Related Disorders
The purpose of this study was to examine whether treatment response to fluoxetine by depressed outpatients was predicted by early improvement on any of 3 subscales (Anxiety, Depression, and Anger/Hostility) of the Symptom Questionnaire... more
The purpose of this study was to examine whether treatment response to fluoxetine by depressed outpatients was predicted by early improvement on any of 3 subscales (Anxiety, Depression, and Anger/Hostility) of the Symptom Questionnaire (SQ). We evaluated 169 depressed outpatients (52.6% female) between ages 18 and 65 (mean age, 40.3 +/- 10.6 years) meeting DSM-IIIR criteria for major depressive disorder (MDD). All patients completed the SQ at baseline (week 0) and at weeks 2, 4, and 8 of treatment with fluoxetine 20 mg/d. We defined treatment response as a > or= 50% reduction in score on the 17-item Hamilton Rating Scale for Depression, and early improvement on 3 SQ subscales (Anxiety, Depression, and Anger/Hostility) as a >30% reduction in score by week 2. The percentage of patients with significant early improvement in anger was significantly greater than the percentage of those with early improvements in anxiety or depression. When early improvement on the Anxiety, Depressi...
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ABSTRACT An industrious approach to increasing reimbursement rates from third-party payers is reviewed. Balancing fidelity to treatment with real-world demands at a local hospital is discussed, as well as ways we were able to increase... more
ABSTRACT An industrious approach to increasing reimbursement rates from third-party payers is reviewed. Balancing fidelity to treatment with real-world demands at a local hospital is discussed, as well as ways we were able to increase reimbursement within our own department. Data in naturalistic settings, though not always able to adhere to randomized controlled trials, offers evidence of improvement in symptoms. This reaction paper encourages other clinical programs to "stay in the game" of data collection while balancing treatment fidelity.
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The purpose of this study was to explore the usefulness of the Personality Assessment Inventory (PAI; Morey, 1991) Borderline full scale (BOR) and subscales in the assessment of patients being evaluated for dialectical behavior therapy... more
The purpose of this study was to explore the usefulness of the Personality Assessment Inventory (PAI; Morey, 1991) Borderline full scale (BOR) and subscales in the assessment of patients being evaluated for dialectical behavior therapy (DBT; Linehan, 1993). We administered 67 patients both the PAI and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Structured Clinical Interview for Axis II disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1997). Point biserial correlations showed a significant relationship between the presence of borderline personality disorder (BPD) and scores on the BOR and Schizophrenia (SCZ) scales. A regression analysis showed that among the BOR subscales, those measuring identity disturbance, self-harming behavior, and negative relationships were significantly related to the total number of SCID-II BPD criteria. Diagnostic efficiency statistics between the BOR scale and the number of SCID-II BPD criteria indicated that a T score cutoff of 65 optimally differentiates patients who do and do not meet criteria for BPD. The relationship between BOR and SCID-II BPD demonstrates the concurrent validity of the PAI and shows its usefulness in this setting.
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Treatment resistant depression is common, persistent, and results in substantial functional and social impairment. This study describes the development and preliminary outcome evaluation of a dialectical behavior therapy-based skills... more
Treatment resistant depression is common, persistent, and results in substantial functional and social impairment. This study describes the development and preliminary outcome evaluation of a dialectical behavior therapy-based skills training group to treat depressive symptoms in adult outpatients for whom antidepressant medication had not produced remission. The 16-session, once-weekly group covered the 4 dialectical behavior therapy skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Twenty-four patients with ongoing depressive symptoms despite stable, adequate medication treatment for major depressive disorder were randomly assigned to either the skills group or a wait-list condition. The depressive symptoms of participants who completed the study (9 wait-list participants, 10 skills group participants) were compared using a clinician-rated Hamilton rating scale for depression and then replicated using a self-report measure Beck depression inventory. Clinician raters were blind to each participant's assigned study condition. Skills group participants showed significantly greater improvements in depressive symptoms compared with the control condition. Effect sizes were large for both measures of depression (Cohen's d = 1.45 for Hamilton rating scale for depression and 1.31 for Beck depression inventory), suggesting that larger scale trials are warranted.