DBT

Introduction
The aim of the study is to test the efficacy of two structured therapeutic programs, Dialectical Behavior Therapy (DBT) and Group Experience Therapy (GET) on emotional and behavioral dysregulation in patients with severe Borderline Personality Disorder (BPD) features.

Methods
The study is a randomized and interventional trial; experimental design is longitudinal. Forty subjects diagnosed with severe BPD features are consecutively admitted and randomized in two different day-hospital treatment programs, DBT and GET, at San Raffaele Turro Hospital (Milan, Italy). No differences were found between groups for socio-anagraphic variables and personality traits measured at baseline (all ps = n.s.). Dimensions of emotional dysregulation, self-harm, impulsivity and aggression are assessed at the admission time and during the first year of treatment, every six months. Statistical analyses were conducted with nonparametric and parametric tests (i.e., Repeated Measure ANOVA), and preliminary multilevel analysis.

Results
For both arms of treatment significant changes were found on main features of dysfunctional behaviors, emotional dysregulation, and coping strategies. The results showed a significant decrease during treatments in emotion dysregulation in almost all dimensions, self-harm and aggression scores (ps < .005), for both treatments. The reduction of trait impulsivity seems to be not significant in both samples. Comparison of the two treatment programs showed only small effects.

Discussion
Both structured treatments for BPD seemed to be effective on behavioral and emotional dimensions, even after six months. Some hypothetical implications for clinical practice were deduced considering common and specific therapeutic factors of the two treatment programs.

The mindfulness ‘foundations’ of existential-phenomenology appeared at the turn of the twentieth-century.  Humanistic psychology’s affinity with phenomenology emerged in the latter half of the mid twentieth-century.  Yet the Cognitive Behavioral Therapy (CBT) third wave mindfulness literature does not appear to have turned toward full collaborative acknowledgment of its neighboring precursors.  A revised history of Western mindfulness-based work and psychology is thus provided.  Parallels among Phenomenological-Humanistic Psychology (PHP), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT) are also discussed.  Specifically, non-judgmental observation and description, validation, acceptance, intuition, doing and being, bodily mindfulness, letting be, and meaning-making are reviewed.  Herefrom, the CBT third wave is invited into generative intra-disciplinary dialogue with PHP.

At this time, it does not appear that existential phenomenology and humanistic psychology (PHP) have formed inclusive, process-oriented frameworks that reference the sociocultural and contextual significations embedded in the flow of everyday human experience. And yet, apart from the welcome variety of psychotherapy approaches comprising PHP, the founding existential phenomenological and humanistic thinkers had already addressed cultural issues in their writings.  In addition, these same founding thinkers had already developed mindfulness meditation perspectives well ahead of the mindfulness-based Cognitive Behavioral Therapy third wave. This article considers the link between PHP’s emphasis on attuned mindfulness and meditative sociocultural awareness as part of an emerging Mindful and Multicultural Humanistic-Existential Psychotherapy (MMHEP) approach.  MMHEP fluidly supports both mindfulness and meditative attunement to clients’ culture-near or context-near experiences as part of an experience-near attentiveness to the groundless ground of experience.  By re-uniting the landscape of “inward” possibilities for bare and present moment mindfulness with the meditative awareness of “outer” sociocultural realms, a client may integratively connect with a greater sense of wholeness as a sociocultural-being-in-the-world.

Fourteen ‘treatment resistant’ problem gamblers received 9 weeks of Dialectical Behavior Therapy (DBT) at specialist problem gambling services delivered in Melbourne, Australia. This study is the first to investigate the effectiveness of a brief DBT treatment for problem gambling, with a focus on measuring change in the four DBT process skills (mindfulness, distress tolerance, emotion dysregulation, and negative relationships). Although there were no statistically significant improvements in measures of gambling behaviour, 83% of participants were abstinent or reduced their gambling expenditure pre- to post-treatment. Participants also reported statistically and clinically significant improvements in psychological distress, mindfulness, and distress tolerance. Moreover, there were no increases in alcohol or substance use. These results are discussed in the context of focusing on a single
DBT process skill, and the benefits of using group-based approaches.

Keywords: problem gambling, dialectical behavior therapy, borderline personality, disorder, treatment

The current paper discusses an approach to measuring treatment integrity of dialectical behavioral therapy (DBT) when implemented within two programs providing services to street-involved youth in the community. Measuring treatment integrity is a critical component of effective implementation of evidence-based interventions in clinical practice, since sound treatment integrity increases confidence in client outcomes and intervention repli-cability. Despite being an essential part of implementation science, few studies report on treatment integrity, with limited research addressing either measurement tools or maintenance of treatment integrity. To address the lack of available treatment integrity measures, researchers in the current study developed and piloted a treatment integrity measure which pertain to the individual and group components of DBT. A total of 20 recordings were assessed using the treatment integrity measure. Results indicate that the community agency staff (e.g. youth workers, social workers & nurses) implemented the intervention as intended; increasing confidence in the outcome variables, the staffs' training and the replicability of the intervention. This article offers one approach to addressing treatment integrity when implementing evidence-based interventions, such as DBT in a community setting, and discusses the need for effective and feasible integrity measures that can be adopted in order to strengthen mental health practice in community settings.

Objective: There is a dearth of practice-based evidence of adapted or ‘DBT-informed’ transdiagnostic models, which could provide services and clinicians with information of what works and for whom, in which settings.  This paper aims to bridge this gap by exploring the client experience of a 12-week transdiagnostic dialectical behaviour therapy (DBT) group programme in a private psychiatric hospital. Method: Five participants with varied clinical diagnoses and previous therapeutic experiences were interviewed following completion of one or more of the same adapted DBT programme, comprising of the standard four modules over 12 weeks, including a weekly skills group and 1:1 therapy.  Interpretative phenomenological analysis (IPA) was applied to give voice to the clients’ lived experience of the group. Results: Three master themes were identified: ‘Pre DBT: Crisis & Desperation’; ‘In-session: Belonging’; and ‘The Real World: Living’, each characterised by 4 sub-themes, highlighting helpful and hindering factors of clients’ current and previous therapeutic experiences.  Conclusion: Overall this version of DBT in a transdiagnostic setting was experienced as helpful and positive by participants; main outcomes included being able to build a life worth living, feel hope and joy, build DBT skills into a lifestyle, and develop reflective practice. Implications for clinical practice, service delivery and policy are also discussed.  The article aims to provide clinicians with practice-based evidence to inform the delivery of DBT as well as supporting the case for the use of DBT with various disorders, thus paving the way for future research in this area.

The current study implemented and evaluated a 12-week Dialectical Behavior Therapy (DBT) intervention across two Canadian service agencies providing drop-in, shelter and transitional housing to street-involved youth in order to alleviate mental health challenges and to strengthen resilience. A quasi-experimental mixed methods design with a wait-list comparison was used. Overall results demonstrate that youth who received the DBT intervention (N = 60) demonstrated significant improvement in mental health challenges (e.g. depression, hopeless-ness, and anxiety), as well as significant improvement in resilience, self-esteem, and social connectedness immediately post-intervention. Participants in the wait-list control did not demonstrate significant improvement on any of the study outcome measures. Furthermore, the gains attained for the intervention group were sustained at four and 10 weeks post-intervention. The qualitative data substantiates these findings; further shedding light on youth's perspectives regarding the impetus for engaging in DBT, the experience of DBT and the impact DBT had on their lives. Results of this study suggests that DBT implemented by front-line clinicians shows promise in meeting the needs of street-involved youth in the community. Moreover, this study demonstrates that it is possible, with the right approach and support, for an interdisciplinary team of youth workers, nurses, and social workers to implement an evidenced-based treatment with youth at community agencies thereby increasing access to needed services to support youth in ultimately exiting the street.

Si tratta di uno studio preliminare su 25 soggetti con disturbo borderline di personalità trattati per sei mesi con DBT (Dialectical Behavior Therapy) in un contesto di day hospital. La valutazione è stata effettuata in ingresso e a sei mesi di trattamento. Si sono riscontrati significativi miglioramenti in dimensioni rilevanti ai fini dello sviluppo delle capacità di regolazione emotiva.