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Phalen P, Kimhy D, Jobes D, Bennett M. Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review. Eur Arch Psychiatry Clin Neurosci 2024; 274:955-961. [PMID: 37597022 DOI: 10.1007/s00406-023-01675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
There is a pressing need for effective treatments that address the high rate of suicide observed among people with psychosis. In this scoping review we highlight two suicidogenic treatment targets that have been relatively neglected in people with psychotic disorders: emotional distress and emotion dysregulation. We review the research on these constructs in psychosis and their relationship to suicide in this population, and then make clinical recommendations based on research findings. Emotional distress and emotional dysregulation may be promising treatment targets for suicide among people with psychosis.
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Affiliation(s)
- Peter Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA.
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA
- Education and Clinical Center, James J. Peters VA Medical Center, Mental Illness Research, New York, NY, USA
| | - David Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Melanie Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA
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2
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Yu Y, Cui X, Du J, Wilson A, Xu S, Wang Y. Linear and curvilinear association of pain tolerance and social anxiety symptoms among youth with different subgroups of childhood trauma. J Affect Disord 2024; 354:491-499. [PMID: 38508458 DOI: 10.1016/j.jad.2024.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Social anxiety is a common symptom that occurs after exposure to childhood trauma (CT), and pain tolerance is a protective factor against social anxiety in generic populations with CT. However, few studies have investigated whether and how this association varies across different CT subgroups. Thus, this study aimed to investigate (1) the effects of pain tolerance on social anxiety symptoms among youth with different subgroups of CT; (2) the nonlinear relationship between pain tolerance and social anxiety symptoms among different CT categories. METHODS In this study, 15,682 college or university students with experiences of CT were identified in a large sample and divided into five CT subgroups. Linear and quadratic regression models were conducted to explore the association between pain tolerance and social anxiety symptoms among youth with different CT subgroups. RESULTS The results of model revealed a linear relationship between pain tolerance and social anxiety symptoms among youth with most CT subgroups. Notably, an inverted U-shaped curve was found between pain tolerance and social anxiety symptoms in youth with emotional abuse. Social anxiety symptoms increased gradually with pain tolerance scores between 0 and 16, and then sharply decreased when scores reached above 16. LIMITATIONS Limited by self-report measurements, the results of this study focused only on perceived pain tolerance and ignored behavioral pain tolerance. CONCLUSION These findings highlight the importance of assessing pain tolerance thresholds in youth with emotional abuse and improving pain tolerance to prevent social anxiety symptoms in youth with different subgroups of CT.
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Affiliation(s)
- Yi Yu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xin Cui
- Department of Psychology, Faculty of Arts and Sciences, Beijing Normal University, Zhuhai, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmei Du
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.
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3
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Vijayapriya CV, Tamarana R. Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:694. [PMID: 37905964 PMCID: PMC10690726 DOI: 10.4081/ripppo.2023.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023]
Abstract
Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.
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4
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Southward MW, Howard KP, Cheavens JS. Less is more: Decreasing the frequency of maladaptive coping predicts improvements in DBT more consistently than increasing the frequency of adaptive coping. Behav Res Ther 2023; 163:104288. [PMID: 36893659 PMCID: PMC10089667 DOI: 10.1016/j.brat.2023.104288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 01/25/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023]
Abstract
It is well-established that participation in dialectical behavior therapy (DBT) results in patients using adaptive coping strategies more frequently. Although coping skill instruction may be necessary to promote decreases in symptoms and behavioral targets in DBT, it is unclear if the frequency with which patients use adaptive coping skills leads to these outcomes. Alternatively, it is possible that DBT also leads patients to use maladaptive strategies less frequently and that these reductions more consistently predict improvements in treatment. We recruited 87 participants with elevated emotion dysregulation (Mage = 30.56; 83.9% female; 75.9% White) to participate in a 6-month course of full-model DBT delivered by advanced graduate students. Participants completed measures of adaptive and maladaptive strategy use, emotion dysregulation, interpersonal problems, distress tolerance, and mindfulness at baseline and after three DBT skills training modules. Both within- and between-person maladaptive strategy use significantly predicted module-to-module changes in all outcomes whereas adaptive strategy use significantly predicted changes in emotion dysregulation and distress tolerance, although the size of these effects did not significantly differ between adaptive and maladaptive strategy use. We discuss the limitations and implications of these results for optimizing DBT.
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5
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Lee S, Arora IS. The effectiveness, acceptability, and sustainability of a 4-week DBT-informed group therapy in increasing psychological resilience for college students with mental health issues. J Clin Psychol 2023. [PMID: 36920177 DOI: 10.1002/jclp.23509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/08/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE An adapted, time-limited dialectical behavior therapy (DBT) skills training group therapy can prove to be an evidence-based treatment that can easily fit the needs, demands, and limitations of University Counseling Centers to serve college students with mental disorders. The present naturalistic study investigated the effectiveness, acceptability, and sustainability of a 4-week DBT-informed group therapy in enhancing psychological resilience. METHODS Participants included 59 college students with heterogeneous mental health concerns. They attended weekly 1.5-hr DBT-informed, resilience-building group therapy for 4 weeks. Psychological resilience, mindfulness, emotional dysregulation, and overall distress were assessed at pretreatment and posttreatment, as well as at 1- and 3-month follow-ups. RESULTS Findings showed increased psychological resilience among the participants at posttreatment and follow-ups, and provided preliminary evidence for the role of mindfulness as an important contributor to enhancing psychological resilience even after controlling for risk factors, treatment dosage, pregroup psychological resilience, and changes in emotion dysregulation and overall distress. CONCLUSION A 4-week DBT-informed skills training group therapy can be utilized as a time-efficient, cost-effective, well-accepted preventative treatment with the potential longitudinal impact to boost psychological resilience for college students with mental health issues.
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Affiliation(s)
- Soonhee Lee
- Counseling Center, University of Maryland, Baltimore County (UMBC), Baltimore, Maryland, USA
| | - Ishita Sunita Arora
- Department of Human Services Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, Maryland, USA
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6
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Mushquash AR, Grassia E. Coping during COVID-19: examining student stress and depressive symptoms. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2266-2269. [PMID: 33513079 DOI: 10.1080/07448481.2020.1865379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/26/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
Objective: College students have faced widespread changes and challenges as a result of the novel coronavirus disease of 2019 (COVID-19) pandemic. How students cope with these disruptions is important in determining the ongoing impacts of the pandemic on mental health and well-being. We evaluated the associations between COVID-19 stress, coping responses, and symptoms of depression. Participants: A sample of 131 students (106 female; 25 male) was recruited throughout May 2020. Methods: Participants completed online self-report measures of study constructs. Results: As predicted, students experiencing more stress related to COVID-19 endorsed more symptoms of depression. Student stress was also associated with less use of engagement coping responses. Primary engagement and secondary engagement coping responses mediated the relationship between COVID-19 stress and symptoms of depression. Conclusions: Students lacking in adaptive, engagement coping responses may be particularly at risk for psychopathology when faced with high levels of stress related to COVID-19.
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7
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Martin S, Del-Monte J. Just try it: Preliminary results of a six-month therapy for borderline personality disorder. Personal Ment Health 2022; 16:338-349. [PMID: 35751447 PMCID: PMC9787760 DOI: 10.1002/pmh.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
Borderline Personality Disorder (BPD) is labeled as a personality disorder with impulsivity issues regarding relationships, risky behavior, and emotional dysregulation. This personality disorder is still considered to be hard-to-treat condition even though responses to treatment have improved significantly. In this field, Dialectical Behavioral Therapy is recognized as one of the most efficient therapeutical approaches, and some versions adapted from this gold-standard treatment proved their effectiveness in clinical settings. We tested the 6-month cognitive behavioral therapy (CBT) protocol ECCCLORE, composed of three modules, respectively, working on emotional regulation, distress tolerance, and relationships-in a French context to compare its effectiveness to Treatment As Usual. We recruited 56 patients with a BPD diagnosis in a day-care unit, 34 receiving ECCCLORE and 22 receiving TAU. We assessed BPD traits, impulsivity, aggressiveness, suicidal risk, and hopelessness. Our results revealed the effectiveness of the 6-month ECCCLORE protocol to decrease BPD symptoms and associated clinical dimensions. We also noted the persistence of its effect after a 1-year follow-up. Shortened CBT treatment protocols tend to prove their efficiency for symptom reduction in BPD. Further research is needed to replicate these results.
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Affiliation(s)
- Sylvia Martin
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.,Psycho-TCCE, Private Practice, Nîmes, France
| | - Jonathan Del-Monte
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.,Psycho-TCCE, Private Practice, Nîmes, France.,Clinical Psychology Department, Nîmes University, Nîmes, France.,LPS laboratory, Aix-Marseille University, Aix-en-Provence, France
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8
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Stinson J, Wolfe R, Spaulding W. Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy. Behav Sci (Basel) 2022; 12:bs12080253. [PMID: 35892353 PMCID: PMC9394355 DOI: 10.3390/bs12080253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022] Open
Abstract
Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.
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Affiliation(s)
- Jessica Stinson
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
- South Texas Veterans Healthcare System, San Antonio, TX 78229, USA
- Correspondence:
| | - Rebecca Wolfe
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
| | - Will Spaulding
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
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9
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Yang MJ, Sawhney V, McHugh RK, Leyro TM. Examination of the indirect effect of childhood emotional trauma on internalizing symptoms through distress intolerance. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1347-1353. [PMID: 32877634 DOI: 10.1080/07448481.2020.1810053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Extant studies document a prospective link between early childhood trauma and internalizing symptoms, such as anxiety and depression. Less is known regarding specific cognitive-affective mechanisms. The current study sought to examine distress intolerance (DI) as a mechanism that may explain the relation between early childhood emotional abuse and internalizing symptoms. PARTICIPANTS AND METHODS Participants (N = 230; 54.3% women; mean age = 19.72, SD = 2.28) completed multiple self-report indices of early childhood emotional abuse, DI, and internalizing symptom indices. Using structural equation modeling, a series of mediation models was run to examine the indirect effect of childhood emotional abuse on latent and specific internalizing symptom indices through a latent index of subjective DI. RESULTS Childhood emotional abuse was significantly associated with internalizing symptoms through DI (effect size range = .083-.227, medium to large). CONCLUSIONS The results provide preliminary evidence for DI as a mechanism of interest in the relation between early childhood emotional abuse and internalizing symptoms.
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Affiliation(s)
- Min-Jeong Yang
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Vyom Sawhney
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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10
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Phalen P, Grossmann J, Bruder T, Jeong JY, Calmes C, McGrath K, Malouf E, James A, Romero E, Bennett M. Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System. EVALUATION AND PROGRAM PLANNING 2022; 92:102098. [PMID: 35525095 DOI: 10.1016/j.evalprogplan.2022.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/30/2021] [Accepted: 04/17/2022] [Indexed: 06/14/2023]
Abstract
A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6-8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.
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Affiliation(s)
- Peter Phalen
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States.
| | | | | | - Jae Yeon Jeong
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
| | | | | | | | | | - Erin Romero
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
| | - Melanie Bennett
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
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11
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The Mediating Role of Mindfulness in the relationship between emotional distress tolerance and coping Styles in Turkish University students. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022. [DOI: 10.1007/s10447-022-09469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Lamb R, Crowe A, Stone J, Annetta L, Zambone A, Owens T. Virtual reality enhanced Dialectical behavioural therapy. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2022. [DOI: 10.1080/03069885.2022.2040006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Richard Lamb
- Neurocognition Science Laboratory, College of Education, East Carolina University, Greenville, NC, USA
| | - Allison Crowe
- Department of Interdisciplinary Professions, College of Education, East Carolina University, Greenville, NC, USA
| | - Jessica Stone
- Neurocognition Science Laboratory, College of Education, East Carolina University, Greenville, NC, USA
| | - Leonard Annetta
- Neurocognition Science Laboratory, College of Education, East Carolina University, Greenville, NC, USA
| | - Alana Zambone
- Department of Special Education, Foundations, and Research, College of Education, East Carolina University, Greenville, NC, USA
| | - Tosha Owens
- Department of Special Education, Foundations, and Research, College of Education, East Carolina University, Greenville, NC, USA
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13
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Panteli M, Papantoniou A, Vaiouli P, Leonidou C, Panayiotou G. Feeling Down in Lockdown: Effects of COVID-19 pandemic on emotionally vulnerable individuals. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000211064905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We examined whether young adults with internalizing psychopathology during the pre-COVID-19 pandemic period exhibited different patterns of emotional responses than those without such psychopathology during the implementation of the “lockdown” in Cyprus, Greece. Two-wave longitudinal research was conducted i one hundred six college students completing measures of affective experiences, mental health, and quality of life during the prepandemic and lockdown periods. Increased negative affect and internalizing symptoms during the prepandemic period and decreased positive affect and increased perceived stress during the lockdown period both significantly predicted increased internalizing symptoms during the lockdown period. We discuss findings within the context of actions and interventions for young adults with existing internalizing symptomatology during the COVID-19 pandemic.
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Affiliation(s)
- Maria Panteli
- University of Cyprus,
- Center for Applied Neuroscience,
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14
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Randomized clinical trial of a brief, scalable intervention for mental health sequelae in college students during the COVID-19 pandemic. Behav Res Ther 2022; 149:104015. [PMID: 34958980 PMCID: PMC8689580 DOI: 10.1016/j.brat.2021.104015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
This randomized clinical trial aimed to determine feasibility, acceptability, and initial efficacy of brief Dialectical Behavior Therapy (DBT) skills videos in reducing psychological distress among college students during the COVID-19 pandemic. Over six weeks, 153 undergraduates at a large, public American university completed pre-assessment, intervention, and post-assessment periods. During the intervention, participants were randomized to receive animated DBT skills videos for 14 successive days (n = 99) or continue assessment (n = 54). All participants received 4x daily ecological momentary assessments on affect, self-efficacy of managing emotions, and unbearableness of emotions. The study was feasible and the intervention was acceptable, as demonstrated by moderate to high compliance rates and video ratings. There were significant pre-post video reductions in negative affect and increases in positive affect. There was a significant time × condition interaction on unbearableness of emotions; control participants rated their emotions as more unbearable in the last four vs. first two weeks, whereas the intervention participants did not rate their emotions as any more unbearable. Main effects of condition on negative affect and self-efficacy were not significant. DBT skills videos may help college students avoid worsening mental health. This brief, highly scalable intervention could extend the reach of mental health treatment.
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15
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Pilatti A, Michelini Y, Bravo AJ, Pautassi RM. The Association between Distress Tolerance and Alcohol Outcomes via Internal Drinking Motives. Subst Use Misuse 2022; 57:230-238. [PMID: 34789052 DOI: 10.1080/10826084.2021.2002900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Previous work suggests that college students who perceive themselves as less able to tolerate negative affect are more motivated to use alcohol to alleviate psychological distress. Recent findings also indicate that distress tolerance influences alcohol outcomes via a positive reinforcement pathway. However, results concerning the association between distress tolerance and alcohol outcomes remain inconsistent. Aim: The present study examined the association between distinctive features of distress tolerance and alcohol outcomes via internal drinking motives (i.e., coping and enhancement) in Argentinean college students. Method: From April to November 2019, a sample of 387 college students with last-month alcohol use (Mean age = 21.09 ± 4.98) completed an online survey assessing alcohol outcomes (past-month frequency of binge drinking and negative alcohol-related consequences), internal drinking motives, and four components of distress tolerance (i.e., tolerance, appraisal, absorption, and regulation). Results: The associations between specific facets of distress tolerance and drinking outcomes were atemporally mediated by coping and enhancement motives. Coping motives significantly mediated the effect of absorption and appraisal on alcohol-related problems (i.e., lower absorption and lower appraisal were associated with more problems via higher coping motives). Enhancement motives significantly mediated the effect of absorption (lower absorption was associated with greater enhancement motives) on binge drinking frequency and alcohol-related problems. Conclusions: Distress tolerance was associated with alcohol outcomes via coping and enhancement motives in this sample of Argentinean undergraduates. The ability to withstand negative affect could be a focal point of interventions to prevent the development of maladaptive patterns of drinking.
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Affiliation(s)
- Angelina Pilatti
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina.,IIPsi-CONICET-UNC, Instituto de Investigaciones Psicológicas, Córdoba, Argentina
| | - Yanina Michelini
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina.,IIPsi-CONICET-UNC, Instituto de Investigaciones Psicológicas, Córdoba, Argentina
| | - Adrian J Bravo
- Department of Psychological Sciences, William & Mary, USA
| | - Ricardo Marcos Pautassi
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina.,INIMEC-CONICET-UNC, Instituto de Investigación Médica M. y M. Ferreyra, Córdoba, Argentina
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16
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Ramsey KA, De Nadai AS, Espil FM, Ricketts E, Stiede JT, Schild J, Specht MW, Woods DW, Bennet S, Walkup JT, Chang S, Piacentini J, McGuire JF. Urge intolerance predicts tic severity and impairment among adults with Tourette syndrome and chronic tic disorders. Front Psychiatry 2022; 13:929413. [PMID: 36032236 PMCID: PMC9399515 DOI: 10.3389/fpsyt.2022.929413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges-aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance-difficulty tolerating premonitory urges-predicted tic severity and tic-related impairment among adults with TS. METHODS Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance-comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model. RESULTS Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment. CONCLUSION This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Emily Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Jordan T Stiede
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Jennifer Schild
- Department of Psychology, Choices Youth Psychopathology Lab, Suffolk University, Boston, MA, United States
| | - Matthew W Specht
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - Douglas W Woods
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Shannon Bennet
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - John T Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
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17
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Saini AK, Wal P, Wal A, Pal RS, Verma OP. A Narrative Review on Dialectical Behavior Therapy for Patients with Depressive Difficulties. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082218666211220153312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy (CBT) that was earlier intended to treat only patients with borderline personality disorder (BPD), but researchers have found DBT to treat several psychological disorders, including depression.
Aim:
The article aims to review the clinical shreds of evidence regarding the use of DBT to treat depression.
Methods:
PubMed literature search was done by applying the year filter range, 2010 to 2021. Another filter applied was "Randomized controlled trial", so that the strength of evidence could be enhanced. The keywords used were "Dialectical Behavior Therapy" AND "Depression
Results:
33 articles were found, out of which only 20 relevant articles were reviewed. DBT was found to alleviate depressive symptoms associated with different psychological disorders like bipolar disorder and BPD but the number of studies that validated the afore-mentioned were less than those studies which showed that DBT had no significant effect on the patients with depressive difficulties. The long-term effect of DBT for treating depression is under a suspect, as studies showed DBT got ineffective during the follow-ups
Conclusion:
DBT shows benefits in depression but further studies are still required to validate this concretely as DBT did not show a significant effect when compared to its control counterparts. There is much need for future studies which can evaluate the long-term efficacy of DBT in depression is another challenging area because follow-up data did not favor DBT.
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Affiliation(s)
- Aryendu Kumar Saini
- Department of Psychology, Indira Gandhi National Open University, Banaras Hindu University (B.H.U.) Regional Centre, Varanasi, India
| | - Pranay Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Ankita Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Rashmi Saxena Pal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Om Prakash Verma
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
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18
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Van Swearingen KM, Lothes JE. Symptom reduction in DBT-informed partial hospital, intensive outpatient, and step-down programs: Mindfulness matters. Psychother Res 2021; 32:640-651. [PMID: 34806559 DOI: 10.1080/10503307.2021.2001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Preliminary evidence suggests the efficacy of Dialectical Behavior Therapy (DBT) to reduce clinical symptoms in Partial Hospital (PH) programs. However, less is known about DBT in Intensive Outpatient (IOP) programs, or in PH to IOP step-down models. The current study examined changes in depression, anxiety, stress, hopelessness, and mindfulness skills acquisition, from intake and discharge data of clients at a southeastern behavioral health clinic in the United States. The sample included 146 clients, 65.75% female (ages M = 33.88, SD = 12.34), who attended either a DBT-PH, -IOP, or -PH to IOP step-down program. Participants completed the Depression, Anxiety, Stress Scale (DASS-21), Beck Hopelessness Scale (BHS), and Five Facets of Mindfulness Questionnaire Short Form (FFMQ-SF). Depression, anxiety, and hopelessness decreased from intake to discharge in the PH program, while all symptoms decreased in the IOP and step-down programs. Mindfulness total scores, and most subscales, increased in each program. Mindfulness skills acquisition predicted decreases in depression and stress in the IOP group, and decreases in depression and hopelessness in the step-down group. Overall, clinical symptoms and mindfulness skills acquisition improved over the course of the DBT-PH and-IOP programs.
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Affiliation(s)
| | - John E Lothes
- College of Health & Human Services, University of North Carolina, Wilmington, NC, USA
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19
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Interactive Effects of Perceived Parental Rearing Styles on Distress Tolerance and Psychological Distress in Pakistani University Students. JOURNAL OF ADULT DEVELOPMENT 2021. [DOI: 10.1007/s10804-021-09373-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Kannan D, Chugani CD, Muhomba M, Koon K. A Qualitative Analysis of College Counseling Center Staff Experiences of the Utility of Dialectical Behavior Therapy Programs on Campus. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2021; 35:53-59. [PMID: 33718945 DOI: 10.1080/87568225.2019.1620662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dialectical behavior therapy (DBT) is an evidence-based practice for suicidal and self-injuring behavior with growing popularity in college counseling centers (CCCs). With the exception of a single, quantitative study, no research to date investigates how DBT is used in CCCs or what factors influence program implementation. We conducted qualitative interviews with 15 CCC staff that were delivering DBT programs in order to inform a more richly detailed understanding of the process of developing and implementing a DBT program housed in a CCC.
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Affiliation(s)
- Divya Kannan
- Psychological and Counseling Center, Vanderbilt University, Nashville, TN
| | - Carla D Chugani
- University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Monicah Muhomba
- Psychological and Counseling Center, Vanderbilt University, Nashville, TN
| | - Kimberly Koon
- Psychological and Counseling Center, Vanderbilt University, Nashville, TN
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21
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Chugani CD, Fuhrman B, Abebe KZ, Talis J, Miller E, Coulter RWS. Wellness and resilience for college and beyond: protocol for a quasi-experimental pilot study investigating a dialectical behaviour therapy skill-infused college course. BMJ Open 2020; 10:e036833. [PMID: 32565475 PMCID: PMC7311003 DOI: 10.1136/bmjopen-2020-036833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION College students' mental health problems and suicidal behaviour are serious, persistent and prevalent public health issues. With the need for mental health support greatly exceeding the availability of on-campus treatment, a recent trend on college campuses is to offer courses designed to teach students strategies for developing mental health or resilience. While these courses are exceptionally popular among students, a paucity of research investigates the health outcomes associated with participation. The purpose of this study is to investigate the acceptability, appropriateness, feasibility and preliminary effectiveness of a college course grounded in skills from dialectical behaviour therapy (DBT) titled, 'Wellness and Resilience for College and Beyond'. METHODS AND ANALYSIS During the spring and fall 2020 semesters, the course will be offered on five campuses in Southwestern Pennsylvania and West Virginia. The course consists of 15 weekly 2.5-hour lessons, weekly homework assignments and a final examination with content drawn from DBT, acceptance and commitment therapy and positive psychology. Undergraduate students aged 18-24 will self-select into the course and control subjects receiving 'university as usual' will be recruited to serve as a comparison group. Students who receive the course will complete measures of course acceptability, appropriateness and feasibility. All study participants will complete measures of adaptive coping skills use, emotion dysregulation and suicidality. ETHICS AND DISSEMINATION All of the study procedures were approved as an exempt protocol for evaluation of educational curricula by the University of Pittsburgh Human Research Protections Office (HRPO); the study was approved as a research study by the institutional review board (IRB) of the fifth study site. The University of Pittsburgh HRPO served as the IRB of record for all except one study site, which required standard IRB review. Data from this study will be disseminated via conference presentations, peer-reviewed publications and via our online stakeholder learning collaborative. TRIAL REGISTRATION NUMBER NCT04338256.
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Affiliation(s)
- Carla D Chugani
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Barbara Fuhrman
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kaleab Z Abebe
- School of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Elizabeth Miller
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert W S Coulter
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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22
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Lee S, Mason M. Effectiveness of Brief DBT-informed Group Therapy on Psychological Resilience: A Preliminary Naturalistic Study. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2018. [DOI: 10.1080/87568225.2018.1425646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Soonhee Lee
- University of Maryland, Baltimore County (UMBC), Baltimore, Maryland, USA
| | - Mark Mason
- University of Delaware, Newark, Delaware, USA
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