Mapping Treatment Components to Targets in Dialectical Behavior Therapy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 84
- 试验地点
- 2
- 主要终点
- Change in Emotional Functioning - Linear
研究概览
简要总结
Although dialectical behavior therapy (DBT) skills training is effective in the treatment of borderline personality disorder, it contains four skills modules and there is little research to guide their modular application. This study compares the unique effects of two distinct DBT skills training modules, relative to a non-DBT therapy group for adults with borderline personality disorder. Using innovative laboratory-based assessment methods, the proposed study will examine the effects of these conditions on emotional responding and interpersonal functioning, as well as clinical outcomes.
详细描述
Borderline personality disorder (BPD) is a severe mental health condition with high morbidity and mortality. Although dialectical behavior therapy (DBT) is an efficacious treatment for BPD, it is resource-intensive and lengthy in its full form, involving one year of weekly individual therapy and group skills training in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. As a result, few patients have access to the full treatment. A better understanding of how the distinct components of DBT affect different sets of symptoms could help to streamline this treatment and personalize its use with specific patients.
Improvements in both interpersonal and emotional functioning are theorized to underlie improvements in BPD. Thus, emotion regulation and interpersonal effectiveness skills training may be particularly important components of DBT. Therefore, this study examines the unique effects of two distinct DBT skills training modules.
Participants are adults with BPD and recent, recurrent self-injurious behaviors (planned N = 81) who are randomly assigned to six weeks of DBT emotion regulation skills training (DBT-ER), DBT interpersonal effectiveness skills training (DBT-IE), or a non-skills control group. Using innovative laboratory-based multimethod assessments, this study examines the effects of these conditions on emotional responding and interpersonal functioning, as well as BPD related outcomes. Aim 1 examines the unique effects of DBT-ER and DBT-IE on their respective emotion-related (subjective and biological emotional reactivity, behavioral emotion regulation, skills use) and interpersonal (subjective and behavioral) targets, compared to the non-DBT treatment. Aim 2 examines whether improved emotional functioning predicts reductions in BPD symptoms and self-injury. Aim 3 examines whether baseline emotion dysregulation interacts with treatment condition to predict treatment response.
The proposed research is innovative in its experimental examination of the effects of DBT components on specific targets in BPD. Given the high societal costs of BPD, this work has important public health significance. Findings will inform larger studies evaluating the potential modular use of DBT components to result in briefer and more efficient individualized treatments for patients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Basic Science
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •exhibit 4+ BPD symptoms,
- •have a history of recent (i.e., past-year) and recurrent (> 1 instance) of self-injury,
- •commit to participate in one of our 6-week experimental groups,
- •have an individual health provider who can manage imminent issues,
- •be between 18-60 years old,
排除标准
- •not fluent in English,
- •have impaired (uncorrected) vision or hearing that would impair ability to understand study stimuli,
- •a current manic, psychotic, or active physiological dependence on substances (to limit interference in the lab),
- •low cognitive functioning (IQ ≤ 70.4 (TOPF; Pearson Assessments, 2009),
- •past DBT treatment
结局指标
主要结局
Change in Emotional Functioning - Linear
时间窗: Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14
Assessed with the Difficulties in Emotion Regulation Scale (DERS), which has total scores that range from 36-180, with higher scores indicating more difficulties. Outcomes are reported as slopes (scores over weeks, centered around the start of treatment, with standard errors) per condition, extracted from mixed effects/multilevel models. This measure is listed separately to permit presentation of two units of measure (that are in the same model) - the Linear unit of measure (DERS scores/week), and the Quadratic unit of measure (DERS scores/week\^2). This measure reflects the Linear measure.
Change in Borderline Personality Disorder Features - Linear
时间窗: Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14
Assessed with the abbreviated Borderline Symptom List (BSL23), which has mean scores that range from 0-4, with higher scores indicating more symptoms. Outcomes are reported as slopes (scores rescaled \*100 over weeks, centered around the start of treatment, with standard errors) per condition, extracted from mixed effects/multilevel models. This measure is listed separately to permit presentation of two units of measure (that are in the same model) - the Linear unit of measure (BSL scores/week), and the Quadratic unit of measure (BSL scores/week\^2). This measure reflects the Linear measure.
Change in Emotional Functioning - Quad
时间窗: Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14
Assessed with the Difficulties in Emotion Regulation Scale (DERS), which has total scores that range from 36-180, with higher scores indicating more difficulties. Outcomes are reported as slopes (scores over weeks, centered around the start of treatment, with standard errors) per condition, extracted from mixed effects/multilevel models. This measure is listed separately to permit presentation of two units of measure (that are in the same model) - the Linear unit of measure (DERS scores/week), and the Quadratic unit of measure (DERS scores/week\^2). This measure reflects the Quadratic measure.
Change in Borderline Personality Disorder Features - Quad
时间窗: Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14
Assessed with the abbreviated Borderline Symptom List (BSL23), which has mean scores that range from 0-4, with higher scores indicating more symptoms. Outcomes are reported as slopes (scores rescaled \*100 over weeks, centered around the start of treatment, with standard errors) per condition, extracted from mixed effects/multilevel models. This measure is listed separately to permit presentation of two units of measure (that are in the same model) - the Linear unit of measure (BSL scores/week), and the Quadratic unit of measure (BSL scores/week\^2). This measure reflects the Quadratic measure.
次要结局
- Change in Self-reported Emotional Reactivity(Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7)
- Change in Self-reported Emotional Regulation(Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7)
- Change in Affect-modulated Startle(Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7)
- Change in Emotional Habituation(Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7)
- Change in Physiological Emotional Reactivity(Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7)
- Change in Deliberate Physiological Emotional Regulation(Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7)
研究者
Katherine Dixon-Gordon
Associate Professor
University of Massachusetts, Amherst