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Keenan EG, Gurba AN, Mahaffey B, Kappenberg CF, Lerner MD. Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights. AUTISM IN ADULTHOOD 2024; 6:1-8. [PMID: 38435330 PMCID: PMC10902278 DOI: 10.1089/aut.2022.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Autistic people may experience high emotion and sensory sensitivities and a slow return to baseline emotional state. Dialectical behavior therapy (DBT) was developed to address reactivity, impulsivity, and mood dysregulation in individuals with mood and personality disorders. DBT may be therapeutically beneficial to autistic individuals struggling with these or similar emotional and sensory challenges. This article is a synthesis of the first author's experiences of DBT as an autistic person and professional insights from all authors. We provide an overview of the development of DBT, its foundational components, and adaptations. Using this basis, the first author describes the benefits DBT has had, the modifications that have helped him, and how those modifications may enhance DBT for autistic people. Modifications include visuals, graphics, and a gaming format that target the client's personal interests. The essence of these alterations is to transform life skills and DBT skills into something meaningful and functional. Receptivity of the therapist to the modifications and neurodivergent problem solving may be foundational to therapeutic success. Client-initiated contributions in collaborative therapy may improve autistic participants' understanding, validation, and adherence with DBT. The authors suggest expanding work on DBT modifications for autism in the areas of daily self-monitoring, assessing for preferred visual and gaming formats, and utilizing personal interests.
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Affiliation(s)
| | - Ava N. Gurba
- Stony Brook University, Stony Brook, New York, USA
| | | | - Catherine Faith Kappenberg
- University of California, Los Angeles, Los Angeles, California, USA
- Stony Brook University, Stony Brook, New York, USA
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Gilmartin T, Dipnall JF, Gurvich C, Sharp G. Identifying overcontrol and undercontrol personality types among young people using the five factor model, and the relationship with disordered eating behaviour, anxiety and depression. J Eat Disord 2024; 12:16. [PMID: 38267972 PMCID: PMC10809654 DOI: 10.1186/s40337-024-00967-4] [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] [Received: 09/22/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Overcontrol and undercontrol personality types have been associated with an increase in eating pathology, depression and anxiety. The aim of the research was to explore whether latent overcontrol and undercontrol personality types could be identified using cluster analysis of the facets of the five factor model (FFM). We further aimed to understand how these personality types were associated with eating pathology, depressed mood and anxiety. METHODS A total of 561 participants (394 women and 167 men), aged 16-30 years in Australia completed a survey designed to assess disordered eating, FFM personality traits, anxiety, depression and stress. A systematic four-step process using hierarchical, k-means, and random forest cluster analyses were used to identify a meaningful 3-cluster solution. RESULTS The results revealed a cluster solution that represented overcontrol, undercontrol and resilient personality types, and highlighted facets of the FFM that were associated with each type. Both overcontrol and undercontrol personality types were associated with increased clinical symptoms compared to the resilient types. CONCLUSIONS It was concluded that FFM facets may potentially be more meaningful than broad domains in identifying personality types, and that both overcontrol and undercontrol personality types are likely associated with increased clinical symptoms.
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Affiliation(s)
- Tanya Gilmartin
- Department of Neuroscience, Monash University and the Alfred Hospital, Melbourne, Australia.
| | - Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
| | - Caroline Gurvich
- Department of Psychiatry, HER CENTRE Australia, Central Clinical School, Monash University, Melbourne, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University and the Alfred Hospital, Melbourne, Australia
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Arco L. Toward a synthesis of cognitive behaviour therapy via component analysis of self-regulation. Clin Psychol Psychother 2023. [PMID: 37855427 DOI: 10.1002/cpp.2918] [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: 03/27/2023] [Revised: 09/15/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
The cognitive behavioural therapies (CBTs) are the choice psychotherapies for many clinicians treating a wide range of adult psychological disorders including various anxieties, mood, substance use, eating, schizophrenia and personality-related. Empirical research in the CBTs is ever increasing, and the accumulating evidence supporting efficacious treatments is substantial and well documented. However, with prolific research comes a seemingly accelerating and worrying trend of purportedly different therapies, and numerous hybrids and combinations of therapies and techniques. For many clinicians this is increasingly confusing and not helpful in clinical practice. This article is a critique of current trends and directions in clinical research, which show signs of limited effectiveness, fragmentation, and obfuscation. An alternative strategy is proposed-examining transdiagnostic therapeutic effects, which appear related to treating pervasive dysregulated emotions, with component analyses of four principal self-regulation components (viz., self-monitoring; functional analysis; identifying values, goals and treatment-plans; and feedback). Such a strategy is likely to lead to a more coherently synthesized and effective CBT.
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Affiliation(s)
- Lucius Arco
- Praxis Research, Perth, Western Australia, Australia
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Frías Á, Palma C, Salvador A, Aluco E, Navarro S, Farriols N, Aliaga F, Solves L, Antón M. B·RIGHT: usability and satisfaction with a mobile app for self-managing emotional crises in patients with borderline personality disorder. Australas Psychiatry 2021; 29:294-298. [PMID: 32438869 DOI: 10.1177/1039856220924321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional crises. To date, crisis interventions for BPD have been conducted via telephone calls and emergency units, which are associated with an extra amount of resources. The aim of this research was to test the usability and satisfaction with a psychotherapeutic mobile app for self-managing crises in BPD. METHOD The B·RIGHT app was designed based on Artificial Intelligence psychotherapeutic algorithms. Usability and satisfaction with the app were assessed in 25 outpatients diagnosed with BPD (84% female, mean age = 35.80 years) using the System Usability Scale (SUS) and other questionnaires. Clinical features were assessed using the Borderline Symptom List, the Difficulties in Emotion Regulation Scale and Beck's Depression Inventory. RESULTS Patients with BPD considered the app user-friendly (mean total score = 4.03) and highly satisfactory (mean total score = 4.02), resulting in a positive user experience (mean total score = 4.09). Total usability was negatively associated with age (r = -.44), positively associated with educational level (rho = .47) and with overall emotion dysregulation (r = .51), and negatively associated with depression severity (r = -.47). CONCLUSIONS The usability and satisfaction testing of the B·RIGHT app showed promising findings, which warrant further research in order to validate its effectiveness.
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Affiliation(s)
- Álvaro Frías
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Spain; and Consorci Sanitari del Maresme. Department of Psychiatry, Hospital of Mataró, Spain
| | - Carol Palma
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Spain; and Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Spain
| | - Ana Salvador
- Department of Psychiatry, Parc Salut del Mar, Spain
| | - Elena Aluco
- Department of Psychiatry, Consorci Sanitari of Terrassa, Spain
| | - Sara Navarro
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Spain; and Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Spain
| | - Núria Farriols
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Spain; and Consorci Sanitari del Maresme. Department of Psychiatry, Hospital of Mataró, Spain
| | - Ferrán Aliaga
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Spain; and Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Spain
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Spain
| | - Meritxell Antón
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Spain
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Toms G, Williams L, Rycroft-Malone J, Swales M, Feigenbaum J. The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review. Borderline Personal Disord Emot Dysregul 2019; 6:2. [PMID: 30805193 PMCID: PMC6373034 DOI: 10.1186/s40479-019-0102-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is a third wave behaviour therapy combining behaviour based components with elements of mindfulness. Although DBT effectiveness has been explored, relatively little attention has been given to its implementation. Frameworks are often the basis for gathering information about implementation and can also direct how the implementation of an intervention is conducted. Using existing implementation frameworks, this critical literature review scoped the DBT implementation literature to develop and refine a bespoke DBT implementation framework. METHOD AND RESULTS The initial framework was developed by consolidating existing implementation frameworks and published guidance on DBT implementation. The critical literature review retrieved papers from Medline, CINAHL, PsycInfo, PubMed, and the reference lists of included papers. Framework elements were used as codes which were applied to the literature and guided the synthesis. Findings from the synthesis refined the framework.The critical literature review retrieved 60 papers but only 14 of these explicitly focused on implementation. The DBT implementation framework captured all the execution barriers and facilitators described in the literature. However, the evidence synthesis led to a more parsimonious framework as some elements (e.g., research and published guidance) were seldom discussed in DBT implementation. CONCLUSION To our knowledge this is the first published review exploring DBT implementation. The literature synthesis suggests some tentative recommendations which warrant further exploration. For instance, if DBT implementation is not pre-planned, having someone in the organisation who champions DBT can be advantageous. However, as the literature is limited and has methodological limitations, further prospective studies of DBT implementation are needed.
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Affiliation(s)
- Gill Toms
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Lynne Williams
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Jo Rycroft-Malone
- Gill Toms, School of Healthcare Sciences, Bangor University, Fron Heulog, Bangor, Gwynedd LL57 2EF UK
| | - Michaela Swales
- North Wales Clinical Psychology Programme, School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd LL57 2DG UK
| | - Janet Feigenbaum
- Research Department of Clinical, Education and Health Psychology, University College London, Gower Street, London, WC1E 6BT UK
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Conrad AM, Sankaranarayanan A, Lewin TJ, Dunbar A. Effectiveness of a 10-week group program based on Dialectical Behaviour Therapy skills among patients with personality and mood disorders: findings from a pilot study. Australas Psychiatry 2017. [PMID: 28648090 DOI: 10.1177/1039856217707393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Community mental health services are often required to manage people experiencing repeated crises. Personality disorders are not uncommon, accounting for up to one-third of such presentations. These patients are often difficult to treat, leading to a revolving-door phenomenon. This study evaluated the effectiveness of a pilot intervention in reducing psychological symptoms and distress, and examined the impact of the intervention on mental health service utilization. METHODS A pre- versus post-treatment evaluation was conducted of the effectiveness of a 10-week group psychological intervention based on Dialectical Behaviour Therapy skills, conducted in a regional Australian community mental health service with patients diagnosed with either Cluster B personality disorder or a mood disorder. RESULTS Of those who completed the program ( N = 38 patients), 84% were female, with an average age of 35.13 years. Participants were active clients of the service for an average of 58.3 weeks prior to the program. They demonstrated significant improvements in quality of life and self-control, and a reduction in hopelessness, cognitive instability and dependence on mental health services. CONCLUSIONS Limiting the Dialectical Behaviour Therapy program to a short-term skills-based group component was successful with the targeted patient group; however, more research is required to establish the generalizability of these results.
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Affiliation(s)
- Agatha M Conrad
- Research Officer, Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health and the University of Newcastle, Newcastle, NSW, Australia
| | - Anoop Sankaranarayanan
- Hunter Valley Mental Health Service, Hunter New England Mental Health, Maitland, NSW, and; Director of Medical Services, Mental Health South Western Sydney Local Health District-Mental Health Service, Sydney, NSW, Australia
| | - Terry J Lewin
- Research Manager, Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health and the University of Newcastle, Newcastle, NSW, Australia
| | - Anna Dunbar
- Clinical Nurse Consultant, Hunter Valley Mental Health Service, Hunter New England Mental Health, Maitland, NSW, Australia
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Affiliation(s)
- M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India E-mail:
| | - M Starlin Vijay
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India E-mail:
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