DBT-SS for Cognitively Challenged Individuals With Deliberate Self-harm
- Conditions
- Self HarmSuicide, AttemptedBorderline Personality Disorder
- Interventions
- Behavioral: Dialectic Behavior Therapy - Skills System
- Registration Number
- NCT03627663
- Lead Sponsor
- Region Skane
- Brief Summary
The study evaluates the effect of Dialectic Behavior Therapy Skills System (DBT-SS) in individuals with Intelligence Quotient 65-85 and recurrent self-harm. The study is primarily descriptive with 6 cases followed by repeated measurements (weekly; time series analysis). Primary outcome measure is frequency and severity of self-harming behavior, reported weekly 4 weeks before the start of the intervention, throughout the intervention and 12 weeks after the intervention has stopped.
- Detailed Description
Not many psychotherapies are adapted to suit individuals with Intelligence Quotient(IQ) in the lower normal range. For individuals diagnosed with cognitive disability and self-harm, psychiatric treatment as usual often consists of only supportive meetings and sometimes heavy medication.
Dialectical Behavior therapy (DBT) is one of the evidence based treatments for individuals with self-harm and Borderline Personality Disorder. It is a comprehensive, multi component treatment, usually lasting a year or more. When offering DBT to individuals with cognitive disabilities or IQ in the lower normal range, it is necessary to alter the individual therapy procedures and skills group materials, while remaining adherent to DBT principles.
The Skills System is an adaptation of the standard DBT skills for individuals with cognitive challenges, well suited for IQ 65-85. When adapted DBT individual therapy integrates the Skills System as the skill group curriculum the treatment is called DBT-Skills System (DBT-SS). DBT-SS comprises weekly individual sessions, weekly group education and separate education for caregivers and/or near standing persons. The method is tested with positive effects on problem behaviors, however results need to be reproduced, and further tested in a randomized controlled trial. The handouts from Skills System has recently been translated to Swedish.
The current study aims to investigate the effect of Skills system on individuals with self-harm, IQ 65-85 and three or more symptoms of borderline personality disorder. A single-case time series design will be used with repeated, weekly measurements before, during and after the intervention is provided. 6 participants will be recruited in a pilot study, to investigate the feasibility of the method in a Swedish setting. Main outcome measures are frequency and severity of self-harming and aggressive behaviors, number of days with hospital admission and coercive care, number of medications, and self-rated level of daily functioning. Participation will last 64-70 weeks depending on when the group therapy starts in relation to enrollment.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 6
- Ongoing contact with adult psychiatric clinic
- Intelligence Quotient 65-85
- Current self-harming behaviour at least twice the last six months
- Staff from residential care or near standing persons are able to participate in the treatment by participating in group sessions.
- Schizophrenia or Bipolar illness type 1
- Substance abuse
- Non-psychiatric disorder significantly contributing to symptoms.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Intervention Dialectic Behavior Therapy - Skills System Receiving treatment with Dialectic Behavior Therapy - Skills System + Treatment As Usual
- Primary Outcome Measures
Name Time Method Deliberate self-harm Baseline - 64 weeks Frequency of deliberate self-harm
- Secondary Outcome Measures
Name Time Method Coercive care Baseline - 64 weeks Number of days with coercive care
Coercive acts Baseline - 64 weeks Number of coercive acts
Worried Baseline - 64 weeks Number of hours per week when the individual is worried
Medication on demand Baseline - 64 weeks Frequency of occasions with medication on demand
Problem behaviors Baseline - 64 weeks Frequency of problem behaviors
Out-of control behavior Baseline - 64 weeks Number of hours per week with out-of control behavior
Upset Baseline - 64 weeks Number of hours per week when the individual is upset
Visits to psychiatric emergency ward Baseline - 64 weeks Frequency of visits to psychiatric emergency ward
Admission to hospital Baseline - 64 weeks Number of days admitted to hospital
Vulnerability Baseline - 64 weeks Measurement with Short-Term Assessment of Risk and Treatability
Psychotropic medications Baseline - 64 weeks Number of psychotropic medications
Level of risk Baseline - 64 weeks Measurement with Short-Term Assessment of Risk and Treatability
Resilience Baseline - 64 weeks Measurement with Short-Term Assessment of Risk and Treatability
Level of functioning Baseline - 64 weeks Self-rated by interview level of functioning in daily life with WHODAS 2.0
Trial Locations
- Locations (1)
Division of Psychiatry, Region Skåne
🇸🇪Lund, Skåne, Sweden