Dialectical Behavior Therapy (DBT; Linehan, 1993) is an empirically supported, skills based, cognitive-behavioral therapy used to treat a myriad of symptoms including chronic suicidality and self-harm, emotion dysregulation, reactive aggression and other mood dependent behaviors. Because of its emphasis on self-regulation and a wide range of problem behaviors, DBT can be readily applied to sex offender treatment programming. In this workshop, participants will learn about DBT’s method of conceptualizing and addressing client problems, important strategies for engaging offenders in treatment using this approach, and DBT skills. Important updates from the most recent DBT skills manual will also be addressed. be discussed.

In the past decade the push for utilization of evidence-based practice (EBP) in mental health has increased dramatically. Due to managed healthcare, lowered spending on state and federal mental health budgets, and requirements by funding agencies such as Medicaid, it is imperative that mental health clinicians (MHCs) be trained in and utilize EBPs to improve funding and ensure continuity of best practice in clinical interventions with clients. Minimal research exists on MHCs and their knowledge and use of EBPs. The present study examined MHCs' perceptions, knowledge, training, and utilization of EBPs, with a specific focus on Dialectical Behavior Therapy (DBT). To date, it is the most prominent and effective EBP for treating Borderline Personality Disorder (BPD) and associated parasuicidal and suicidal behaviors. Current research supports its effectiveness in treating a myriad of other commonly treated disorders. The exploratory study provides insight into MHCs level of interest in receiving more EBP awareness and DBT training. Results indicate that though clinicians have received training in EBP and DBT, most of that training has been encouraged through career settings. Age of the clinician, years in practice, and type of training background are predictors of level of education, knowledge and training. Results show the majority of clinicians are interested in EBP, aware of the impact EBP can have on treatment effects, and report desire to have more training in EBPs and DBT specifically. These results could provide a necessary bridge between disciplines to allow clinicians, irrespective of training, to provide the most clinically effective treatments to clients. / Ph. D.

<p dir="ltr">Overcontrol is a coping style common to many psychiatric disorders that involves rigidity, goal persistence, and relying on a strict set of beliefs to manage aversive experiences. Overcontrol is associated with many core deficits, including disorders of internalizing and difficulties with social function. In clinical observation, it has been noted that there are two subgroups of patients with overcontrol, those who are “overly agreeable” and “overly disagreeable”. This work aimed to examine the role of agreeableness in overcontrol, investigating whether there exist important differences in psychiatric or psychosocial functioning at the poles of agreeableness. This study found evidence of this non-linear relationship for certain outcomes. For example, the relationship between internalizing distress and emotion dysregulation was non-linear in nature, meaning particularly low/high agreeableness in combination with overcontrol predicted more depression and dysregulation. Further nuance to these findings were investigated in exploratory analyses. Contrary to expectations, there was no evidence for a curvilinear role of agreeableness in social functioning, however, overcontrol was significantly related to loneliness. Further, there were many associations between agreeableness, overcontrol and interpersonal values, lending credence to clinical observation that people high in overcontrol hold certain values about their interpersonal context which may not be overtly expressed. Taken together, this paper offers support for the Radically Open Dialectical Behavioral Therapy conceptualization of behavior, providing empirical support to the agreeableness subgrouping.</p>

Background: Dialectical behavior therapy (DBT), an outpatient intervention, has shown efficacy in reducing suicidality. Less is known about its effectiveness when delivered in usual care (UC), and the resource-intensive nature of the program often results in modifications when implemented in usual care. Methods: A systematic search yielded 83 empirical evaluations of DBT that reported original data on at least one of three suicidality-related outcomes: (a) self-directed violence (SDV), (b) crisis service use (CSU), and (c) suicidal ideation (SI). Using meta-analysis, the current study (1) estimated pooled effect of DBT in UC, (2) compared effects in UC and non-UC settings, and (3) examined predictors of differential outcomes. Results: DBT demonstrated a large effect (g=.81) in reducing SDV and a medium effect in reducing SI (g=.68). The estimated effect on CSU (g=.60) was non-significant after adjusting for publication bias (g=.29). DBT was more effective than control conditions in reducing SDV (g=.50), even after adjusting for publication bias (g=1.63). No differences between UC and non-UC effects were detected. In uncontrolled studies, positive associations emerged between therapist training and SDV reduction, adherence-reporting and CSU reduction, and outpatient and SI reduction. Discussion: Results support DBT’s effectiveness in reducing suicidality-related outcomes in UC, but should be interpreted with caution given the heterogeneity among studies. Potential sources of heterogeneity and the methodological challenges of synthesizing research in UC are discussed. Recommendations for future work are offered. / Psychology

Mindfulness is a core component of dialectical behavior therapy (DBT), a widely utilized treatment for borderline personality disorder (BPD); however, the import of mindfulness in treating BPD has yet to be demonstrated, and the relationship of mindfulness to BPD constructs is unclear. The current study utilized structural equation modeling to examine the relations of mindfulness with BPD features and the underlying constructs of interpersonal problem-solving effectiveness, impulsivity, emotion regulation strategies, and neuroticism in 342 young adults. Mindfulness was significantly related to effectiveness in interpersonal problem-solving, impulsivity and passivity in emotion regulation, and borderline features. Furthermore, mindfulness continued to predict borderline features when controlling for interpersonal problem-solving and impulsive/passive emotion-regulation strategies, as well as when controlling for neuroticism. It is concluded that difficulties with mindfulness may represent a core feature of BPD and that improvement in mindfulness may be a key component of treatment efficacy with BPD. It is recommended that the unique contribution of mindfulness be investigated in future treatment-outcome research.

Purpose: Describe the Suquamish cultural influences on defining living a life worthwhile and to describe the compatibility of a culturally modified Dialectical Behavior Therapy (DBT) with a Native American community's culture and context. Background: Native Americans experience serious psychological distress, suicide, and substance abuse at higher rates than other racial groups. Studies using DBT found a significant decrease in parasuicidal risk behavior and substance abuse. However, research has not demonstrated that DBT is efficacious or compatible within the Native American culture. Specific Aims: 1) Describe the Native American cultural influences on defining living a life worthwhile. 2) Describe the compatibility between Healthy and Whole, a culturally modified DBT intervention with Native American culture. Methodology: Critical ethnographic study with in-depth interviews (13) and participant observations (10 months) was conducted. Sample was tribal members and clinicians exposed to the Healthy and Whole and tribal members who are identified as knowledgeable regarding tribal tradition. Analyses included semantic domain, taxonomic, and theme analysis for aim1 and compared DBT curriculum to results of aim 1 to accomplish aim 2.Findings: An intergenerational cycle of relational trauma was initiated by structural cultural genocide with systematic abuse and neglect of Native Americans especially children. Relational trauma of abuse and neglect is the source of a variety of maladaptive behaviors. These maladaptive behaviors lead to relational trauma in the next generation. A dual process of maintaining and revitalizing Suquamish cultural values coupled with skills taught in a culturally modified DBT intervention, Healthy and Whole, help Suquamish members live more worthwhile lives and recover from intrapersonal trauma. Implications: Healthy and Whole is a community approach to healing from relational trauma. Healthy and Whole approach to DBT may help other indigenous people live more worthwhile lives and recover from relational trauma and break the cycle because Suquamish cultural values are collectivist and many indigenous peoples share similar values and histories of historical trauma.

Research Doctorate - Doctor of Philosophy (Clinical Psychology) / Overgeneral autobiographical memory is thought to be a clinically meaningful phenomenon which is related to affect regulation, problem solving ability, and treatment outcome in clinical populations (see J. M. G. Williams et al., 2007, for review). Individuals with Borderline Personality Disorder (BPD) are thought to be particularly prone to developing an overgeneral style of memory due to their temperamental difficulties in controlling affect (J. M. G. Williams, 1996). However, research in this population has so far yielded inconsistent findings. In a series of three studies, this thesis addresses the question whether overgeneral memory is associated with BPD, as well as exploring the relationship between memory specificity, affect regulation, problem solving ability, and response to treatment in this population. Findings indicate that individuals with BPD display reduced autobiographical specificity relative to controls, however, this appears to be a reflection of differences in cognitive ability as IQ and education mediated the association between specificity and diagnosis. Reduced specificity was not associated with Borderline traits in a non-clinical sample. Results failed to confirm the hypothesis that autobiographical memory specificity would be related to affect regulation in individuals with BPD, although there was some indication that memory specificity is associated with reduced rates of deliberate self-harm. Specificity was related to problem solving performance in individuals with BPD, although this relationship did not extend to self-reported problem solving ability. Memory specificity also appeared to change significantly over the course of treatment in a year-long Dialectical Behavior Therapy program, however, there was little indication that change in memory specificity was associated with the observed improvement in symptomatology, affect regulation or problem solving ability. Lastly, an experimental study with university students found no relationship between memory specificity and affect dysregulation, although low specific students reported greater reductions in positive affect following a negative event than individuals with a specific style of autobiographical recall. The assimilation model is considered as a framework for conceptualising these results.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2007 / Thesis submitted in partial fulfillment for the degree of Master of Social Work. Includes bibliographical references (leaves 102-108).

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