Dissertations / Theses: 'Dialectical behavior therapy'

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Archard, Rachael. "Adolescents' evaluation of dialectical behavior therapy." Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/11393/.

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There is a large amount of research on BPD which highlights the pervasive and distressing nature of this disorder along with its resulting high financial cost to services. Previous research exploring intervention options for BPD have found DBT to beneficial in reducing parasuicidal behaviour and it is acknowledged as the intervention of choice for adults. The research evidence on ‘what works’ for adolescents with BPD is limited, although DBT is an intervention offered in clinical practice. This study aims to contribute to the research on the effectiveness of DBT by exploring adolescents’ experience of receiving this therapy. Five participants took part in the study and verbatim transcripts from their interviews were analysed using Thematic Analysis. The aim of the analysis was to develop understanding on what adolescents found to be the most and least helpful aspects of DBT and to help ascertain whether participants viewed this therapy as effective in reducing their presenting difficulties. Results identified four main themes which were constructed from the data set; ‘Clinical Picture’, ‘Deciding to start DBT’, ‘Evaluation of DBT’ and ‘Change’, with each theme containing between two and six sub-themes. The themes were seen to connect with each other to represent participants’ journey through therapy. Clinical implications of the research indicate that clinicians play an important role in the process of therapy and contribute to both positive and negative experiences. It appears there is a need for clinicians working with this client group to be appropriately trained and skilled to provide flexible care. In addition the findings from the current study suggest DBT did not target the multiple and varied problems the adolescents presented with, resulting in on-going difficulties and high levels of disengagement and drop-out rates. Whilst participants felt the intervention contained positive elements, overall they reported dissatisfaction with the outcome of therapy. Services may therefore need to consider alternative or additional intervention options to target adolescents’ presenting difficulties and help improve their quality of life.

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Lillard, Richard P. "Dialectical behavior therapy a meta-analysis /." Theological Research Exchange Network (TREN), access this title online, 2005. http://www.tren.com/search.cfm?p088-0127.

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Stinson, Jill D. "Got DBT? Dialectical Behavior Therapy in Practice." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7992.

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Bosch, Louisa Maria Clementina van den. "Borderline personality disorder, substance abuse, and dialectical behavior therapy." [Lisse : Amsterdam : Swets & Zeitlinger] ; Universiteit van Amsterdam [Host], 2003. http://dare.uva.nl/document/67403.

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Zsembery, Celeste Lloyd. "Rhetoric in Dialectical Behavior Therapy: Healing Minds Through Argumentation." BYU ScholarsArchive, 2012. https://scholarsarchive.byu.edu/etd/3093.

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The fields of psychology and rhetoric share the goal of improving human mental health and behavior through persuasion. This thesis traces the history of rhetoric and psychology theory, focusing on the parallel theories of Nienkamp's internal rhetoric and Herman's dialogical self. Both theories model the human mind as having multiple psyches that actively interact to interpret human experience and project human behavior. I conclude with a case study of anorexic patients using ethos, pathos, and logos in dialectical behavior therapy (DBT), arguing that principles of rhetoric can help patients with mental disorders cognitively realign their thinking more effectively than drug treatments can.

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Bergqvist, Mirja. "Vad medveten närvaro kan betyda i dialektisk beteendeterapi : Fem patienters och fyra behandlares perspektiv." Thesis, Mälardalen University, School of Sustainable Development of Society and Technology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-6096.

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För att undersöka vad medveten närvaro kan betyda i dialektisk beteendeterapi (DBT) meningskoncentrerades nio intervjuer. Medveten närvaro hade en positiv betydelse för samtliga deltagare. Det centrala för deltagarna var färdigheterna observera och en sak i taget. Färdigheterna hjälpte patienterna att stanna upp i ett negativt händelseförlopp. Behandlarna menade att medveten närvaro hjälpte vid stressrelaterade situationer. Samtliga deltagare underströk betydelsen av färdighetsträningen i grupp och praktiska övningar. Det fanns ett tydligt behov av att förenkla teorin kring medveten närvaro i DBT samt att medveten närvaro behövde få ett större utrymme. Om medveten närvaro kan hjälpa patienter i DBT att stanna upp i ett destruktivt händelseförlopp så är det en verkan av stor betydelse för patienterna såväl som för anhöriga och sjukvården.

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Stehn, Molly. "Dialectical Behavior Therapy Skills Group as Facilitator of Relational Growth." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1397477538.

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Chugani, Carla. "Dialectical Behavior Therapy in College Counseling Centers: Practical Applications and Theoretical Considerations." Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5926.

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Authors over the last two decades have discussed the myriad of challenges present in managing college students with severe mental health disorders. During the same time period, Marsha Linehan developed dialectical behavior therapy (DBT) as an empirically sound intervention for individuals with suicidal and self-injurious behaviors and this treatment grew to be an evidence-based practice for a range of challenging clinical issues. I argue that one solution to continued increases in college students who present for treatment to their college counseling centers with difficult-to-treat mental health issues, including but not limited to, borderline personality disorder (BPD), is to implement DBT programs on college campuses. As such, the purpose of this dissertation is to address both practical and theoretical issues in the implementation of DBT in college counseling centers. In chapter two, I begin by presenting an overview of DBT as a comprehensive treatment model and a review of the research to date related to DBT in college counseling centers. In chapter three, I offer a detailed account of the program development and implementation process of the DBT program housed in the college counseling center at Florida Gulf Coast University. In chapter four, I present an investigation of current trends and barriers to implementation of DBT in college counseling centers. Finally, in chapter five, I present a qualitative inquiry of the experience of BPD as told by individuals who have been successfully treated with DBT. I argue that understanding client experiences and behaviors in context is critically important if one is to be able to respond empathically and compassionately. In essence, these chapters represent my attempt to synthesize two areas that I believe are required for successful implementation of DBT programs that provide good quality care: 1) Navigating the complexities of implementing DBT in college counseling centers as practice setting and 2) Appropriate management for clinician biases and tendencies to stigmatize BPD clients, which interferes with their ability to provide care that is both effective and compassionate.

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Field, Thomas A. "Implementing Dialectical Behavior Therapy for Adolescents in an Acute Inpatient Psychiatric Setting." Thesis, James Madison University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3620455.

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Although evidence-based practices (EBPs) have been identified in the literature, insufficient information exists about how to successfully implement them. As a result, implementation efforts have been met with failures. Little is currently known about what affects the success of implementation efforts for best practices such as Dialectical Behavior Therapy for adolescents (DBT-A) in an acute inpatient psychiatric setting (AIPS). A longitudinal multiphase mixed methods case study examined an implementation effort to provide DBT-A in an AIPS over a 24-month period. The process of implementation was investigated through in-depth interviews, a focus group, and field observations. Six categories were identified that affected the DBT-A implementation in an AIPS: appeal of DBT as a treatment modality, impact on patients, implementer characteristics, the implementation process, organizational dynamics and structure, and staff support. Implications for implementing EBPs within organizational environments are discussed. This study represents the first attempt to use qualitative and mixed methodology to examine the process of DBT implementation in an AIPS.

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Stinson, Jill D., and Valerie Gonsalves. "Got DBT? Understanding and applying Dialectical Behavior Therapy in sex offender treatment." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7907.

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Dialectical Behavior Therapy (DBT; Linehan, 1993) is an empirically supported skills-based, cognitive-behavioral therapy originally developed for use with clients with borderline personality disorder and associated self-harm behavior. Its unique combination of individual therapy, skills group, in vivo skills coaching, and support for the therapists in the form of a weekly consultation team meeting, provide a comprehensive framework for treating difficult behaviors in a client population who do not demonstrate positive outcomes when participating in traditional psychotherapy practice. Multiple randomized control trials have demonstrated its effectiveness in reducing chronic suicidality and self-harm, particularly among those with personality pathology and substance abuse problems. Since its initial use, DBT has been applied to a myriad of treatment needs, including emotion dysregulation, reactive aggression, and other mood-dependent behavior. Recent evidence indicates that self-regulatory problems are quite common among sexual offenders (Stinson, Becker, & Sales, 2008; Stinson, Robbins, & Crow, 2011; Stinson, Sales, & Becker, 2008; Ward & Hudson, 2007), including difficulties with emotion regulation, violent and sexual aggression, interpersonal skills deficits, suicidality, and problems with substance use. Sex offenders benefit from DBT’s emphasis on self-monitoring, interpersonal and emotional skills development, and the use of a hierarchical treatment structure that addresses multiple behavioral problems and life concerns. Further, some sex offenders – particularly those who present with personality pathology or pronounced self-regulatory deficits – may be unable to meaningfully engage in sex offender specific treatment until they address more acute symptomatology. DBT presents an interesting new take on addressing complex emotional and behavioral problems in adolescent and adult sex offenders. Therapists using DBT benefit from a comprehensive and empirically-supported framework, as well as techniques specifically designed to protect clinicians from the burn-out so often associated with treating challenging and high-risk clients. But admittedly, for those unfamiliar with DBT, this novel way of conceptualizing and addressing sex offender clients can be difficult. The primary objective of this workshop is to introduce sex offender therapists to the tenets of DBT and facilitate the implementation of DBT principles and techniques in sex offender treatment. A secondary goal is to familiarize practiced DBT therapists with recent updates to the DBT skills manual.

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Vaillancourt, Kate E. "Outpatient Dialectical Behavior Therapy at a Community Mental Health Center: Outcome Study." Antioch University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1339163723.

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Schmidt, Rooney Erika. "Examining Parent Pretreatment Expectancies and Preferences in Dialectical Behavior Therapy with Adolescents." Thesis, Long Island University, C. W. Post Center, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10273544.

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Dialectical Behavior Therapy for Adolescents (DBT-A) is an acceptance and change-based treatment protocol that includes parent participation, and has been shown to be effective with emotionally dysregulated, suicidal, and self-injurious adolescents (Mehlum et al., 2014, 2016) who often show high rates of treatment utilization and subsequent dropout (Groves, Backer, van den Bosch, & Miller, 2012). Despite its demonstrated effectiveness and despite parents’ active role in treatment, there is limited treatment acceptability data for DBT-A, and even less investigation into the parent perspective. Pretreatment expectancies and preferences are two common factors associated with treatment acceptability that have been shown to influence treatment participation, adherence, and outcomes that can inform methods for enhancing evidence-based treatments, yet remain underinvestigated (Nock & Kazdin, 2001; Wymbs et al., 2015). The primary goal of the current study was to assess parent pretreatment expectancies and preferences prior to entering an outpatient DBT-A program with their adolescents. Twenty-three parents completed two self-report assessment measures just prior to starting treatment: The Parent Expectancies for Treatment Scale (PETS; Nock & Kazdin, 2001), and the Parent Preferences for Treatment form developed for this study to assess preferences for eight alternative treatment delivery formats. Results showed that parents had moderately high overall expectancies for DBT-A ( M = 97.78, SD = 9.03). Subscale analyses indicated high parent expectancies for its credibility (Credibility, M = 52.09, SD = 5.44), moderately high expectancies for child improvement (Child Improvement, M = 23.43, SD = 3.49), and moderate expectancies for parent involvement (Parent Involvement, M = 22.17, SD = 2.98). Highest rated expectancies were related to the credibility of DBT-A as a valuable, worthwhile treatment and the large role of parent involvement in treatment. The four most preferred alternative format options were to add weekly skills training for individual families, weekly individual parenting skills sessions, weekly parent-only support groups, and weekly parent therapy sessions. The two least preferred format options involved partially or fully separating parent and teens in multifamily skills group. This study provides preliminary support for the use of assessing parents’ pretreatment expectancies and preferences for DBT-A as an initial step toward understanding the treatment attitudes and desires of parents with teens referred to DBT-A. Clinical implications for the utility of these findings in clinical practice and future research are discussed.

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Schmidt, Henry. "Perceptions of the therapeutic relationship and the prediction of suicidal behavior in dialectical behavior therapy /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/9067.

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Heard, Heidi L. "Cost-effectiveness of dialectical behavior therapy in the treatment of borderline personality disorder /." Thesis, Connect to this title online; UW restricted, 2000. http://hdl.handle.net/1773/9082.

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Rossiter, Rachel. "Exploring the experience of dialectical behaviour therapists challenging therapeutic pessimism related to borderline personality disorder /." Connect to full text, 2008. http://hdl.handle.net/2123/4092.

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Thesis (H. Sc. D.)--University of Sydney, 2008.
Title from title screen (viewed 11 March 2009). Submitted in fulfilment of the requirements for the degree of Doctor of Health Sciences to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

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Dupee, Justin. "Reducing self-harm| Dialectical Behavior Therapy (DBT) for transitional-age youth A grant proposal." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527920.

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The purpose of this project was to partner with a local host agency, locate a potential funding source and write a grant to obtain funding for a Dialectical Behavior Therapy (DBT) group. This DBT project will address the needs of the Transitional Age Youth (TAY) population in Orange County, California. A literature review was conducted to examine the best practices of working with the TAY population, and to examine history, policies, etc. related to DBT. This DBT TAY program will prepare/support TAYs in reducing incidents of self-harm and psychiatric hospitalizations as well as equip them with the skills to find a meaningful role in their community, successfully communicate and interact with friends and family and work toward their stated goals. The actual submission or funding of this grant was not a requirement for the successful completion of the project.

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Spring, Noah Z. "Effects of Dialectical Behavior Therapy Mindfulness Skills Training on Older Adults with Chronic Pain." Xavier University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1396715022.

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Gundel, Friederike [Verfasser]. "Mindfulness Training in Dialectical Behavior Therapy Investigation on Brain Activity by NIRS / Friederike Gundel." Tübingen : Universitätsbibliothek Tübingen, 2021. http://d-nb.info/1234450879/34.

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Stinson, Jill D., and Valerie Gonsalves. "Got DBT? Understanding and Applying Dialectical Behavior Therapy in Sex Offender Treatment, Parts I & II." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7899.

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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.

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Nunley, Robyn Suzanne. "Mental Health Clinicians' Perceptions, Knowledge, Level of Training, and Utilization of Evidence Based Practices with a Specific Focus on Dialectical Behavior Therapy." Diss., Virginia Tech, 2010. http://hdl.handle.net/10919/27699.

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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.

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Sullivan, Deborah A. "Adaptation of Dialectical Behavior Therapy (DBT) to an outpatient adolescent group in a community mental health setting /." Available to subscribers only, 2006. http://proquest.umi.com/pqdweb?did=1324366321&sid=2&Fmt=2&clientId=1509&RQT=309&VName=PQD.

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Hunnicutt, Hollenbaugh Karen Michelle. "An Examination of Characteristics of Clients who Complete and Those who Drop Out of Dialectical Behavior Therapy." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1306858915.

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Hill, Diana Marie m. d. "Appetite-focused dialectical behavior therapy for the treatment of binge eating with purging: A randomized controlled trial." Connect to online resource, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3315761.

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Perseius, Kent-Inge. "Borderline personality disorder : studies of suffering, quality of life and dialectical behavioural therapy." Doctoral thesis, Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-508-9/.

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Kinsey, Kathleen Marie. "A Critical Ethnography of the Compatibility of a Culturally Modified Dialectical Behavior Therapy with Native American Culture and Context." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/321004.

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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.

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Wupperman, Peggilee. "Are Deficits in Mindfulness Core Features of Borderline Personality Disorder?" Thesis, University of North Texas, 2006. https://digital.library.unt.edu/ark:/67531/metadc5332/.

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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.

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Bentley, Eri Suzuki. "An Evaluation of Referral Patterns and Therapy Outcomes at a University Counseling Center: Analysis of a Dialectical Behavior Skills Training Group." DigitalCommons@USU, 2009. https://digitalcommons.usu.edu/etd/400.

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This study was designed to answer two research questions. First, factors associated with placement decisions to three treatment modalities in a university counseling center were examined; the skills training group for dialectical behavior therapy plus individual therapy (DBT), the interpersonal process group plus individual therapy (IP), and individual therapy only (IND). Individual therapy in all three conditions did not follow a specific theoretical orientation. Of 203 participants (55 males, 148 females), 83 were in DBT, 53 were in IP, and 67 were in IND. Client information included demographic variables (e.g., age, gender) and clinical variables (i.e., diagnosis, and scores from Global Assessment of Functioning, the Outcome Questionnaire-45; OQ-45, and the College Adjustment Scale; CAS). As predicted, the results indicated that clinical characteristics played a significant role in referral decision making, with clients in the DBT condition reporting higher clinical severity. Second, the effectiveness of the skills training group (DBT) was examined, testing the hypothesis that people in DBT start out with more clinical problems but make greater progress than those in IP and IND. Treatment outcome was measured by the OQ-45 and the CAS, each collected at multiple time points. Data from 101 people were available for the OQ-45, and 77 people for the CAS. The results did not provide support for the hypothesis. Although significant change was observed over the course of treatment, no clear patterns of superior outcomes for any of the three treatment conditions emerged.

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Schwan-Rosenwald, Lili. "Drawing the line an exploration of Otto Kernberg and Marsha Linehan's understanding of borderline personality disorder : a project based upon an independent investigation /." Click here for text online. Smith College School for Social Work website, 2007. http://hdl.handle.net/10090/1010.

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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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Berzins, R. Erin W. "The role of emotional overcontrol in the acceptance of counselor training feedback." Antioch University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1572968573171083.

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McNair, Louisa Catherine. "Dialectical behaviour therapy for adults with intellectual disabilities." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/dialectical-behaviour-therapy-for-adults-with-intellectual-disabilities(5a2821c3-824c-4cb7-be27-7cceb3cee7f9).html.

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This thesis explores the use of adapted Dialectical Behaviour Therapy (DBT) with individuals with Intellectual and Developmental Disabilities (ID/D). DBT is a multi-modal psychological intervention that aims to increase skills in interpersonal effectiveness, distress tolerance, emotional regulation and mindfulness. It was initially developed for individuals who presented with parasuicidal behaviours, and is recommended for the treatment of Borderline Personality Disorder (BPD). This thesis is presented in five papers; a systematic literature review, three empirical papers (a, b &c), and a critical review and reflection of the research process. The systematic literature review provides a narrative review of published research regarding the adaptations and outcomes of DBT for individuals with ID/D. Seven studies were reviewed using the Evaluative Method for Determining Evidence Based Practice (EBP) (Reichow, 2011). The findings detail the adaptations, results and critical appraisal of the research to date. The empirical papers consider the outcomes of adults with ID/D who received adapted DBT in a community psychological therapies service. The papers present different methodologies, and combined produce a consilience of evidence regarding the suitability of DBT for this population. Paper 2a found significant reductions on measures of depression, anxiety and anger, and increased mindfulness skills amongst 18 participants following DBT. Paper 2b uses repertory grid technique to explore the psychological changes that occur following DBT for seven participants, and found overall changes in personal construing and improvements in self-esteem. Paper 2c considers the psychological changes that occur in further depth through the presentation of two case studies. The case studies consider the complexity and idiosyncrasy of the individuals and gives consideration to the use of repertory grids to identify implicative dilemmas as part of clinical assessments. The final paper provides a critical review with personal reflections of the thesis. The author considers the research and clinical implications of the study.

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Wagner, Till. "Krankheitskosten der Borderline Persönlichkeitsstörung aus gesellschaftlicher Perspektive sowie Effektivität und Effizienz der ambulanten Dialektisch-Behavioralen Therapie unter Versorgungsbedingungen." Doctoral thesis, Humboldt-Universität zu Berlin, Lebenswissenschaftliche Fakultät, 2016. http://dx.doi.org/10.18452/17509.

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Die vorliegende kumulative Promotion umfasst drei veröffentlichte Publikationen, die im Rahmen der Berliner Borderline Versorgungsstudie (BBV-Studie) durchgeführt wurden. In Studie 1 wurde die effectiveness der ambulanten Dialektisch-Behavioralen Therapie (DBT) an N = 47 Patienten mit einer Borderline Persönlichkeitsstörung (BPS), die das DBT-Behandlungsjahr vollständig durchlaufen haben, untersucht. Im Prä-Post-Vergleich zeigten sich für die untersuchten Symptombereiche signifikante Veränderungen und die Effektstärken lagen überwiegend im mittleren Bereich. 77% der Patienten erfüllten nach einem Jahr DBT nicht mehr die diagnostischen Kriterien für eine BPS. In Studie 2 wurden die Krankheitskosten von N = 55 BPS-Patienten in dem Jahr vor der ambulanten DBT umfassend aus einer gesellschaftlichen Perspektive erhoben. Die durchschnittlichen Kosten lagen bei €26.882 (SD = €32.275). Davon gingen mit €17.976 (SD = €23.867) etwa 66% auf die direkten, mit €8.906 (SD = €15.518) knapp 34% auf die indirekten Kosten zurück. In Studie 3 wurden für die N = 47 DBT- compleater die Krankheitskosten im Jahr vor der Therapie mit denen während des DBT-Behandlungsjahres und mit denen während des ersten Katamnesejahres (N = 33) verglichen. Die durchschnittlichen Krankheitskosten lagen im Jahr vor der DBT bei €28.026 (SD = €33.081), während des DBT-Jahres bei €18.758 (SD = €19.450) und sanken innerhalb des Katamnesejahres weiter auf €14.750 (SD = €18.592). Die deutlichsten Kostenreduktionen zeigten sich im stationären Bereich. Hingegen konnten die indirekten Kosten kaum gesenkt werden. Insgesamt weist die vorliegende Promotion darauf hin, dass die ambulante DBT auch unter Versorgungsbedingungen in Berlin wirksam ist. Zudem besitzt die BPS auch in Deutschland eine hohe gesellschaftliche Relevanz. Die Krankheitskosten können deutlich gesenkt werden, wenn BPS-Patienten in einem DBT-Netzwerk behandelt werden. Hieraus ergeben sich erste Hinweise auf die Effizienz der ambulanten DBT.
This thesis includes three publications that were conducted as part of a Berlin wide treatment study (“Berliner Borderline Versorgungsstudie“). In study 1, we examined the effectiveness of dialectical behavior therapy (DBT) for borderline personality disorder (BPD) under the routine health care situation in Berlin. N = 47 patients completed the one-year treatment and provided data. Our findings demonstrate significant improvements on all measures with medium effect sizes. Moreover, at the end of the first treatment year, 77% of the patients no longer met the criteria for a BPD diagnosis. In Study 2, BPD-related cost-of-illness 12 months prior to outpatient DBT was assessed in a sample of N = 55 BPD-patients from a societal perspective. Total cost-of-illness was €26882 (SD = €32275) per patient. €17976 (SD = €23867; 66%) were direct costs and €8906 (SD = €15518; 34%) were calculated as indirect costs. In study 3, societal cost-of-illness of the N = 47 DBT completers was calculated for 12 months prior to DBT and further investigated during DBT-treatment year and during the following year. Total mean annual cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year and €14750 (SD = €18592) during the follow-up year for the N = 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions of inpatient treatment costs, while indirect costs barely decreased. In sum, the present thesis shows that outpatient DBT under routine mental health care conditions in Berlin leads to positive results. Furthermore, mean annual cost-of-illness of German BPD-patients exceed those of many other mental disorders meaning that BPD poses a high economic burden. Importantly, treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Correspondingly, outpatient DBT has the potential to be an efficient treatment.

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Lyng, James L. "Dialectical Behaviour Therapy for Borderline Personality Disorder in the community." Thesis, Bangor University, 2017. https://research.bangor.ac.uk/portal/en/theses/dialectical-behaviour-therapy-for-borderline-personality-disorder-in-the-community(fabd3e78-397d-40f3-9c9f-2b9e0887e69d).html.

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BPD is a severe and chronic psychological disorder associated with high rates of completed suicide and enduring disability. Standard DBT is an evidence-based, multi-modal psychotherapy for BPD which includes individual psychotherapy, group skills training, between-session coaching, and therapist consultation. DBT is effective for reducing many difficulties associated with BPD and can also transfer successfully into the community, yet important practice-relevant questions remain. The work in this dissertation involves four separate studies relating to ways DBT can be delivered in the community and exploring who is likely to respond to DBT. The studies draw on treatment outcome data from a total of 140 patients with a diagnosis of BPD collected over several years by community-based DBT teams involved in a multi-site, practice-based research network (PBRN). In Chapter 2, encouraging outcomes are reported from a small evaluation of standard DBT delivered to a cohort of 18-25 year olds with a diagnosis of BPD in a new young adult only DBT programme. Chapter 3 describes an expanded investigation of this young adult only DBT programme, mainstreamed as an early intervention initiative for 18-25 year olds presenting to community services with a diagnosis of BPD. Better outcomes are reported for the young adult programme compared to similar aged young adults in general adult DBT, suggesting advantages for this age-specific mode of delivery, possibly due to group cohesion. In Chapter 4, largely similar outcomes at six months are found for a rationalised, standalone group skills training adaptation of DBT when compared to standard (i.e. all modes) DBT, with some unexpected advantages for standalone group skills on hopelessness and difficulties in emotion regulation. Treatment conditions are not equivalent due to non-random allocation and the exclusion of higher risk patients from standalone skills, but findings offer support for the usefulness of standalone skills among lower-risk patients with a diagnosis of BPD who are willing to accept a group-only intervention when delivered by experienced DBT therapists. In Chapter 5, patient variables are investigated as predictors of outcome following one year of standard DBT for BPD. Gender, employment status, post-traumatic stress disorder (PTSD), and baseline suicide ideation are reported to be associated with change or recovery on borderline symptom severity and general psychopathology. Overall limitations of the dissertation, such as measurement problems, failure to formally assess treatment fidelity, and the inclusion of only completers in the analysis, are discussed in Chapter 6. In addition, several areas for future research are identified: the benefits of PBRNs, group cohesion as a factor in outcomes for DBT, and further study of young adult DBT under randomised trial conditions with longer term and wider follow-up.

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Kyrning, Helena, and Robert Sjölund. "Exponering för rörelser och emotioner - : En DBT-inspirerad exponeringsbehandling för människor med långvarig ländryggssmärta." Thesis, Örebro universitet, Institutionen för juridik, psykologi och socialt arbete, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-23888.

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SammanfattningLångvarig smärta orsakar stort lidande för individen och belastar samhället ekonomiskt. Syftet med denna uppsats var att undersöka om en exponering in vivo-behandling inspirerad av Dialektisk beteendeterapi (DBT) för människor med långvarig ländryggssmärta var görbar samt om behandlingen gav effekt på smärtrelaterad problematik. Designen var en single case experimental design vilket är en beprövad design för att testa nya terapimetoder. Studien bestod av sex deltagare, alla med hög grad av smärtrelaterade katastroftankar, något som litteraturen visat predicera sämre behandlingsutfall. Behandlingen var DBT-inspirerad och indelad i tre faser; en första valideringsfas, en andra färdighetsfas och en tredje exponeringsfas. Fem av sex deltagare fick förbättringar på alla de primära utfallsmått, tre av sex deltagare fick förbättringar på samtliga primära- och sekundära utfallsmått. Framtida replikationer är motiverade.
AbstractChronic pain causes great suffering for the individual and burden society economically. The aim of this study was to examine whether an exposure in vivo treatment inspired by Dialectical Behavior Therapy (DBT) for people with chronic low back pain was feasible and whether the treatment had effect on pain-related problems. The design was a single case experimental design, which is a widely used design to test new therapy methods. The study consisted of six participants, all with high levels of pain catastrophizing, something that in the literature been linked to poor treatment outcomes. The treatment was inspired by DBT and divided into three phases: an initial validation phase, a second phase for skills training and a third exposure phase. The results were promising: five out of six participants had improved in all primary outcome measures. Three out of six participants had improvements in all primary and secondary outcome measures. Future replications are warranted.

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Desperles, Danielle. "Exploring inpatient experiences of dialectical behaviour therapy for borderline personality disorder." Thesis, University of Leicester, 2010. http://hdl.handle.net/2381/8576.

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Literature Review: A systematic review of the literature on the use of Dialectical Behaviour Therapy (DBT) in both inpatient and outpatient settings was conducted. The results demonstrated that significant treatment gains were made by individuals with BPD when treated with DBT. The review supported the use of DBT in both treatment settings. Research Report: This explored patients’ experiences of DBT in a long term secure inpatient unit. Nine participants diagnosed with BPD were interviewed. The interviews were transcribed and analysed using Interpretative Phenomenological Analysis. A total of eight superordinate themes were identified and summarised separately. The first section related to the DBT programme and two superordinate themes emerged. These were the Components of DBT and the Effects of DBT. The second section examined the journey participants described when undergoing DBT in an inpatient unit. Six superordinate themes emerged, these were: A Hopeless Beginning; the DBT Programme; Promoters of Inpatient DBT; Obstacles of inpatient DBT; A Brighter Future and Preparing for Discharge. The present study highlighted that inpatient uses of DBT are as acceptable as outpatient uses. The journey participants described highlighted the unique promoters and obstacles of inpatient DBT therapy. The clinical implications of this research supported the use of DBT in inpatient settings and provide a rationale for the development of more DBT services. Areas for future research were also discussed. Critical Appraisal: This paper provides an account of the researcher’s reflections and experience of the research process. Issues related to the decision making processes involved in the research and reflections on personal reflexivity are discussed.

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McCormack, Moninne. "Dialectical behaviour therapy : factors relating to dropout and experiences of completion." Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2032759/.

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This thesis focuses on non-completion of dialectical behaviour therapy (DBT) for people with some features of personality difficulties (FPD) and termination of DBT for people with borderline features (BF). It contains two distinct journal papers; a systematic literature review and an empirical paper. The findings from the systematic review are outlined in chapter one. The aim of this review is to summarise the findings from studies that explore what is known about why participants do not complete DBT programmes for FPD and their characteristics. Using a systematic strategy the databases PsycINFO, PubMed, CINAHL, Web of Science, Medline and Scopus were searched for English-language only papers but with no restrictions in relation to date of publication. Papers were selected that included data in relation to dropout of adult participants from DBT for FPD. Eleven papers were included, nine observational studies and two controlled trials. The results are separated into four broad categories; personal characteristics, co-morbidity and distress, environmental and relational factors, and motivation. The results highlight the complexity of factors involved in non-completion of DBT for FPD. Further research using qualitative methods to explore participants’ reasons for non-completion is required to fill a gap in the literature. Chapter two is an empirical study exploring participants' experiences of completing DBT. Little is known about termination experiences of DBT for individuals with borderline features from their own perspectives. This study aimed to explore participants’ experiences of ending a DBT programme and how this experience has influenced their perception of previous endings and management of future endings. Six women were interviewed and their transcripts analysed using Interpretative Phenomenological Analysis. Four key themes were found: (1) fear arising from the powerful influence of previous experiences of ending, (2) engagement with the therapeutic structure of DBT to manage the ending, (3) experiencing the ending of DBT as a reparative process and (4) personal growth during the DBT programme resulting in an awareness of enhanced resilience for the future. Clinical implications highlight the importance of services and therapists to provide an experiential reparative process of therapy termination for service users.

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Priebe, Kathlen. "Evaluation der Dialektisch-Behavioralen Therapie der Posttraumatischen Belastungsstörung nach sexueller Gewalt in Kindheit und Jugend." Doctoral thesis, Humboldt-Universität zu Berlin, 2019. http://dx.doi.org/10.18452/20581.

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Die Posttraumatische Belastungsstörung (PTBS) nach sexueller Gewalt in der Kindheit geht häufig mit komorbiden Symptomen einher. Kognitiv-behaviorale Therapien haben sich als effektiv in der Behandlung der PTBS erwiesen. Die Datenlage zur PTBS nach sexueller Gewalt in der Kindheit ist jedoch gering. In der vorliegenden Dissertation wurden Fragestellungen zur Diagnostik und Therapie der PTBS nach sexueller Gewalt verfolgt. In Schrift 1 werden die Ergebnisse einer ambulanten Assessmentstudie präsentiert, in der 28 Patientinnen wiederholt zum intrusiven Wiederleben befragt wurden. Mit durchschnittlich 75 Intrusionen und 24 Flashbacks pro Woche fand sich eine hohe Symptombelastung. Die Schriften 2, 3 und 4 beziehen sich auf eine randomisiert-kontrollierte Studie. Patientinnen (N=74) wurden randomsiert einer 12-wöchigen stationären DBT-PTBS oder einer treatment-as-usual Warteliste zugewiesen. Die Ergebnisse, die in Schrift 2 beschrieben sind, zeigen eine signifikante Reduktion der posttraumatischen Symptomatik mit einer großen Zwischengruppen-Effektstärke (g=1.35). In Schrift 3 wird dargestellt, dass die Effekte auf die posttraumatische Symptomatik in Bezug auf mehrere traumatische Ereignisse geringer sind als die Effekte in Bezug auf das am stärksten belastende Ereignis. Schrift 4 beinhaltet Ergebnisse zu der Inanspruchnahme psychiatrisch-psychotherapeutischer Behandlung und den assoziierten Kosten. Im Jahr vor der DBT-PTBS fanden sich im Mittel jährliche Pro-Kopf-Kosten von 18100 € und 57 stationäre Tage. Im Jahr nach der DBT-PTBS waren die Inanspruchnahme mit durchschnittlich 14 Tagen und die mittleren Kosten von 7233 € deutlich geringer. Zusammengefasst sprechen die Ergebnisse für eine hohe Effektivität der DBT-PTBS. Zudem scheint die DBT-PTBS mit einer Reduktion stationärer Tage und entsprechender Kosten einherzugehen. Die Ergebnisse zur Diagnostik deuten darauf hin, dass ein Teil der Symptomatik mit dem üblichen diagnostischen Vorgehen nicht erfasst wird.
Posttraumatic stress disorder (PTSD) with co-occurring severe psychopathology is a frequent sequel of childhood sexual abuse (CSA). Cognitive-behavioral therapy has been shown to be efficacious in treating PTSD, but there is only limited data regarding patients with PTSD related to CSA. This dissertation focused on both the assessment and the treatment of PTSD related to CSA. Paper 1 presents data from an ambulatory assessment study. Patients (N=28) were provided with electronic diaries for repeated real-time assessment of intrusions and flashbacks. They reported an average of 75 intrusions and 24 flashbacks during the week of assessment. Papers 2, 3, and 4 present data from a randomized controlled trial. Patients (N=74) were randomized to either a 12-week residential DBT-PTSD program or a treatment-as-usual wait list. The results for primary and secondary outcomes are shown in Paper 2. Data revealed a significant reduction of posttraumatic symptoms with a large between-group effect size (g=1.35). Paper 3 provides results on the impact of the definition of the index trauma. When the index trauma included multiple traumas, PTSD severity scores were significantly higher, and improvements from pre- to post-treatment were significantly lower, compared to when the index trauma was defined as the worst trauma. Paper 4 presents data on the utilization of mental health care. The mean total costs were 18000 € per patient during the year before and 7233 € during the year after DBT-PTSD. The significant cost reduction was due to large reductions in inpatient treatment days (on average 57 days before and 14 days after DBT-PTSD). To sum up, the findings show clear evidence for the efficacy of the DBT-PTSD program. Data further indicate that DBT-PTSD might contribute to reducing the mental health care costs. Also, the results suggest that the currently applied methods of assessing PTSD in patients with severe symptoms might miss aspects of clinically relevant symptomatology.

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Ross, Helen. "Dialectical behaviour therapy for adolescents who repeatedly self-harm : a qualitative study." Thesis, Bangor University, 2002. https://research.bangor.ac.uk/portal/en/theses/dialectical-behaviour-therapy-for-adolescents-who-repeatedly-selfharm--a-qualitative-study(d0104182-26e3-46df-9f7b-bce986401002).html.

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Despite the level of concern generated by adolescents who repeatedly self-harm, there is a dearth of empirically validated interventions for this client group. In the adult domain, dialectical behaviour therapy (DBT; Linehan, 1993) is the only evidence-based intervention for individuals at high risk of repetition, and preliminary research has suggested its utility with adolescents. This study employed a qualitative methodology to evaluate an existing inpatient DBT programme for adolescents with multiple presenting problems including deliberate self-harm. Four female adolescents were interviewed in depth about their experiences and the perceived impact of receiving DBT. Transcripts were analysed for significant and recurrent themes using interpretative phenomenological analysis. Overall, the results supported existing quantitative data indicating that this client group can benefit from DBT. Participants emphasised the role of applying DBT skills in gaining a sense of control over internal experiences and overt behaviours (including self-harm). However, there were marked individual differences in the degree to which such control was attained. Furthermore, for most participants, the effective use of DBT skills was at least partially dependent upon the continued receipt of therapy. Motivation to engage in and comply with therapy appeared to be significantly influenced by participants' perceptions of staff and peers within the inpatient unit. A sense of connection or identification with others emerged as an important source of learning and inspiration, as well as serving to normalise participants' difficulties. The role of social comparison was particularly salient in participants' attempts to make sense of the changes in self since entering DBT. The findings are discussed in relation to the existing literature, with particular emphasis on the extent to which therapeutic processes deemed important by DBT theory were concordant with participants' experiences. Implications for clinical practice are highlighted and directions for future research suggested.

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Wilson, Christina Ann. "Implementation and evaluation of dialectical behaviour therapy for adolescents and for eating disorders." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8540/.

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This thesis contains two volumes. Volume one contains three chapters. The first chapter presents a systematic literature review of Dialectic Behaviour Therapy for young people diagnosed with an Eating Disorder. The second chapter presents an empirical study exploring Dialectic Behaviour Therapy implementation in services supporting young people. The third chapter presents a public dissemination document summarising the literature review and empirical study. Volume two contains five clinical practice reports (CPRs). The first CPR presents a cognitive behavioural formulation and a systemic formulation of a 15-year-old female presenting with low mood. The second CPR presents a service evaluation exploring both clinical leads and managers views of clinical supervision across one NHS Trust. The third CPR used a single-case experimental design to consider the effectiveness of a cognitive behavioural intervention for a 73-year-old female presenting with symptoms of depression and anxiety. The fourth CPR presents a case study of a 20-year-old female with a learning disability and autism, presenting with symptoms of anxiety. The final CPR is a case study abstract from an oral presentation of Cognitive Analytic Therapy, with a 35-year-old female diagnosed with Borderline Personality Disorder.

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Leather, Amanda. "Borderline personality disorder in adolescence : exploring gender differences and effectiveness of dialectical behaviour therapy." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5416/.

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This thesis considers Borderline Personality Disorder (BPD), its diagnosis in adolescence and apparent gender differences in diagnosis and treatment. Although often considered within a clinical mental health context, the gap between clinical and forensic practice is rarely closer than when considering BPD and its close association with an increased risk of criminal behaviour and the forensic population. This coupled with Dialectical Behaviour Therapy (DBT) as a treatment of choice for BPD and its development in a variety of settings including the forensic population means that BPD, adolescence and DBT research is at an interesting juncture. In this controversial area fraught with complications from diagnosis to treatment, it is argued that this thesis could provide a useful collaboration between the available research to date and an exploration of future research developments, which are desperately needed.

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Roberts, Caryl. "Working in adult mental health : burnout and the effects of dialectical behaviour therapy skills training." Thesis, Bangor University, 2018. https://research.bangor.ac.uk/portal/en/theses/working-in-adult-mental-health(98ae9d6a-8e82-42dd-a328-c1ca7ebd39c6).html.

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This thesis aims to explore the predictors of burnout in adult community mental health services and whether DBT skills training is an effective intervention on outcomes for mental health staff. The first chapter consists of a systematic literature review, examining the predictors of burnout in community based mental health staff. In total, 24 studies met the inclusion criteria and consisted of mainly cross sectional survey designs. The review partially supported existing literature on models of burnout, whilst emphasising the importance of personal factors on the development of burnout. The findings were limited due to the lack of studies with longitudinal designs. The second chapter examines the empirical research investigating the relationship of brief DBT skills training on outcomes for mental health staff. 141 mental health staff were recruited at the beginning of the study who completed questionnaires on including burnout, wellbeing, stigma towards clients with BPD, organisational readiness for change, and attitudes towards evidence based practices pre and post training and 39 participants participated at follow up. ANOVA analysis found that the training was significant in reducing stigma towards clients with personality disorder and had a short term effect (from pre to post training) in reducing burnout. The clinical implications and the limitations of the research paper are discussed. The third chapter discusses the papers referred to above with regard to theories and models of burnout potentially providing a psychological explanation for why some factors predict burnout better than others. It also explores why DBT skills training appears to have a small effect on burnout. A reflective commentary is provided at the close of the thesis.

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Woodruff, Joseph Elias. "The Use of Dialectical Behavioral Therapy with the Native American Population in the Southwest." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7355.

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Compared to other races, Native Americans have significantly higher rates of suicide and substance abuse. Dialectical behavioral therapy is an evidence-based program with efficacy for reducing suicidality and comorbid disorders within general populations but may not be effective for Native Americans because it is based in Western ideology. The purpose of this phenomenological study was to explore the lived experiences of Native American therapists who use DBT with Native American populations. Using biosocial theory, I investigated the perceptions and lived experiences of 8 Native American therapists through a phenomenological approach. The research questions encompassed the experiences, including the cultural appropriateness, effectiveness, and treatment barriers and challenges in using DBT. I analyzed data using the interpretive phenomenological analysis. The data displayed 3 superordinate themes from participants: cultural understanding, usefulness of dialectical behavior therapy, and challenges of dialectical behavior therapy. The findings revealed a lack of consensus on how DBT helps Native clients, but participants shared positive experiences using DBT. It was confirmed in the study that knowing the culture, being Native as a provider, understanding generational trauma, and the uniqueness of diversity with different tribes is an asset. The study may have significance for social change by identifying Native American therapists' experiences with using and modifying DBT for Native American clients and potentially providing a pathway for its future use in Native American communities, including current strengths and potential improvements.

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Westwood, Ellen Anne. "The use and outcomes of Dialectical Behaviour Therapy for forensic populations and non-forensic adolescent populations." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7646/.

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Dialectical Behaviour Therapy (DBT) is a type of “talking therapy”, developed from cognitive behavioural therapy; it has been adapted to help people who experience emotions, often females diagnosed with Borderline Personality Disorder (BPD). With its growth in popularity, DBT has been adapted and used with other populations - not just adult females with BPD – to include forensic populations (i.e. people who are in contact with services due to criminal behaviour) and adolescent populations. This thesis contains a systematic literature review investigating the use of DBT in Forensic Services and an empirical study that utilised a qualitative design to explore adolescents and parents’ experiences of DBT.

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Barnicot, Kirsten. "The role of skills use, common and extratherapeutic factors in dialectical behaviour therapy for borderline personality disorder." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8459.

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This thesis investigates the role of specific, common and extratherapeutic factors in dialectical behaviour therapy (DBT) for borderline personality disorder (BPD) with self-harm, using both quantitative and qualitative methods. The overall aim is to generate evidence on the mechanisms by which patients with BPD can achieve change. The premise of the thesis is that DBT has been shown to be more effective than control treatments in reducing self-harm in patients with BPD (Brazier et al. 2007, Binks et al. 2006, Stöffers et al. 2012), but the mechanisms by which this is achieved have not been empirically established. Identification of these mechanisms could enable them to be enhanced in existing interventions or even in routine treatment for patients with BPD, so that improved outcomes are achieved (Llewellyn & Hardy 2001, Kazdin 2007). Theories on the mechanisms of change in psychotherapy have identified three types of factor that may contribute to treatment outcome: specific factors, common factors and extratherapeutic factors. Specific factors are those outlined in the theory of a particular therapy as a central mechanism for patient change (Oei & Shuttlewood 1996). In DBT, patients are taught a set of skills to better regulate their emotions, and patients’ use of these skills is identified in the DBT manual as a key mechanism for achieving change (Linehan 1993a, b). Linked to this, the thesis focuses on three specific factors in DBT: perceived understanding, frequency of use and perceived helpfulness of the DBT skills. Common factors are aspects of treatment which are common to all therapies (Oei & Shuttlewood 1996). The contextual theory outlines several factors common to all successful psychotherapy interventions, and argues that these common 17 factors are the key agents of change (Frank & Frank 1991, Wampold 2001). This thesis focuses on three common factors identified by the contextual theory: treatment credibility, the therapeutic alliance, and self-efficacy. Extratherapeutic factors are factors that influence outcome outside of the treatment context (Lambert 2003, Hubble et al. 2005). This thesis focuses on three extratherapeutic factors linked to social support from friends and family: perceived social support, number of social contacts and number of social confidantes. Previous research has shown that more frequent use of the DBT skills is associated with improved outcomes during DBT (Miller et al. 2000, Neacsiu et al. 2010, Stepp et al. 2008). This could suggest that skill use is a specific change mechanism in DBT. Alternatively, Wampold (2001) suggests that specific factors are associated with therapy outcome only because they enhance common factors. For instance, patients who use the skills more are likely to find their treatment more credible, to have a stronger alliance with their therapist, and to feel a stronger sense of self-efficacy. They may also receive more social support from friends and family. No research to date has examined whether skill use is associated with outcome independently of common and extratherapeutic factors. Such research could yield valuable information on how patients receiving DBT achieve change, and on what factors therapists and researchers should focus when aiming to improve outcomes. The first aim of this thesis is therefore to establish whether skills use is associated with the outcome of DBT for BPD independently of common and extratherapeutic factors. Secondly, patients with BPD are often considered to drop out of treatment more frequently than patients with other mental disorders (Bornovalova & Daughters 2004, 18 Horner & Diamond 1996, Kelly et al. 1992). However, very few studies have examined what processes occurring during treatment are associated with dropout. Previous research has shown that a stronger therapeutic alliance is associated with treatment completion in psychotherapy for BPD (Gunderson et al. 1997, Spinhoven et al. 2007, Yeomans et al. 1994). However, the predictive relevance of specific factors such as DBT skills use, other common factors such as treatment credibility or self-efficacy, and extratherapeutic factors such as social support, has not been evaluated. Furthermore, no study to date has examined whether the DBT skills are associated with treatment completion independently of common and extratherapeutic factors. Such research could enable a better understanding of why patients drop out of DBT treatment, and could inform what factors therapists should focus on to prevent this. The second aim of this thesis is therefore to establish whether skills use predicts treatment completion in DBT for BPD independently of common and extratherapeutic factors. Thirdly, quantitative research on the association between treatment processes and outcomes is arguably limited, because although it can show what factors are associated with outcome, it cannot show how these factors lead to better outcomes. By contrast, qualitative interviews with patients can yield valuable insights on how their experiences in therapy enabled them to achieve change, and can enable identification of barriers to change (Hodgetts & Wright 2007). This in turn can inform future quantitative work by giving an indication of what mediating and moderating factors could be evaluated, and can ensure that researchers’ understanding of change mechanisms during therapy remains rooted in the lived experiences of patients rather than tied to abstract academic theories (Black 1994, Denzin & Lincoln 1994, 19 Greenhalgh & Taylor 1997, Miles & Huberman 1994). Since the main focus of the present thesis is on the DBT skills, the qualitative element focuses on participants’ experiences of learning, using and gaining benefit from the skills. The aims are to explore how patients use the skills and how they come to gain maximum benefit from them, what factors facilitate this and what factors act as barriers to this. Based on the above aims, the thesis addresses the following three research questions: 1) Are the DBT skills associated with outcome independently of common and extratherapeutic factors? Specifically: a) Are the DBT skills associated with self-harm frequency during treatment independently of common and extratherapeutic factors? b) Are the DBT skills associated with BPD symptom severity during treatment independently of common and extratherapeutic factors? 2) Do the DBT skills predict treatment completion independently of common and extratherapeutic factors? 3) How do patients experience learning, using and gaining benefit from the DBT skills? Specifically: a) How do patients use the DBT skills? b) How do patients come to gain maximum benefit from the DBT skills? c) What factors facilitate patients in gaining maximum benefit from the DBT skills? d) What factors act as barriers to gaining maximum benefit from the DBT skills? 20 Questions One and Two are addressed using quantitative methods, whilst Question Three is addressed using qualitative methods. The structure of the thesis is outlined below. Chapters One to Four are Literature Review chapters whilst Chapters Five to Seven present empirical data collected and analysed by the doctoral candidate, and Chapter Eight is a Discussion chapter. Chapter One summarises the nature and treatment of BPD, the DBT model, evidence for its effectiveness and the need for research on its mechanisms. Chapter Two reviews the literature on specific, common and extratherapeutic factors in psychotherapy, describes the contextual model and reviews the evidence for and against it, and reviews evidence on the role of specific, common and extratherapeutic factors in DBT. Chapter Three systematically reviews the literature on predictors of symptom change in psychotherapy for BPD, in order to evaluate the weight of evidence in the field and to identify what potential predictors of outcome should be included in the predictive models evaluated in Chapter Five.

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Magrath, Victoria. "An exploration of eating distress and traumatic experiences in women and the effectiveness of dialectical behaviour therapy." Thesis, University of Warwick, 2012. http://wrap.warwick.ac.uk/59330/.

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This doctoral thesis examines the effectiveness of dialectical behaviour therapy for eating disorders, and explores the lived experience of women with eating distress who also have a history of trauma. The first chapter uses meta-analytic procedures to critically review the current literature to determine whether dialectical behaviour therapy can be regarded as an effective treatment for individuals with eating disorders. The treatment effects across a range of measures were explored, as well as a discussion of the methodological limitations and recommendations for future research. The implications for clinical practice are also considered. The second chapter is an empirical study using a qualitative approach to explore the experiences of eating distress and trauma in women. Women were interviewed to determine their views on the development, daily experience and treatment of their eating distress. The clinical implications and recommendations for future research are discussed, including methodological limitations. The final chapter provides a reflective account of the author’s experience of conducting sensitive research with women with eating distress.

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Woolfall, Emma. "The value of 'third-wave' therapies in Intellectual Disability services : service user experiences of adapted Dialectical Behaviour Therapy." Thesis, Bangor University, 2018. https://research.bangor.ac.uk/portal/en/theses/the-value-of-thirdwave-therapies-in-intellectual-disability-services(785fbb8f-d07f-487b-b667-5fba8276cbcb).html.

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The first chapter consists of a systematic literature review and meta-analysis, which explores the efficacy of using mindfulness-based interventions (MBIs) to reduce stress among both professional and parental caregivers of individuals with intellectual and/or developmental disabilities (IDD). A systematic review returned 2,346 papers, of which, 14 studies met the inclusion criteria (six including professional caregivers, and eight including parental caregivers). Consistent with previous reviews, the meta-analyses identified a small to moderate effect size of MBIs in reducing stress among parental caregivers. No effect was found for professional caregivers; study findings were mixed, although did highlight a possible doseresponse relationship. Further research is necessary in order to develop the evidence base, however preliminary findings show promise for the use of MBIs for caregivers within ID services. The second chapter presents findings from an empirical study, which adopted a qualitative approach to explore service users' experiences of adapted Dialectical Behaviour Therapy (DBT) in community ID services. The principles of interpretative phenomenological analysis (IPA) guided the analysis of semi-structured interviews, conducted with six participants. Four super-ordinate themes emerged from the data; representing the concurrent challenging and rewarding nature of participants' therapeutic journeys. Implications for clinical practice and recommendations for future research are discussed. The third chapter considers theoretical and clinical implications that arose from the first two papers and highlights a significant paucity of research generally within the field of ID. The paper concludes with personal reflections of the research process.

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Childs-Fegredo, Jasmine. "Client experience of receiving adapted Dialectical Behaviour Therapy (DBT) and its perceived role in the process of change." Thesis, University of East London, 2016. http://roar.uel.ac.uk/5817/.

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Research into Dialectical Behaviour Therapy (DBT) has been dominated by the neo positivist paradigm providing clinical practice with a sufficiently robust evidence base for DBT as an intervention, reporting positive outcomes with regards to reducing symptoms of Borderline Personality Disorder (BPD). However, in recent years, DBT has been adapted and replicated to different client groups, offering potential for new research into transdiagnostic applications and adapted versions of DBT to different settings. Recent literature concludes that there is less practice-based evidence on the process of change in DBT, and which components are useful. The client voice is lacking in the literature, which would provide services with evidence and unique insights into how the therapy works and for whom. This study aims to address these questions, by asking the clients how they experience DBT and its perceived role in the process of change. Furthermore, the study focusses on client experience in a private hospital setting with a transdiagnostic group of an adapted 12 week DBT programme. Interpretative Phenomenological Analysis (IPA) was applied as the methodology, incorporating descriptive, linguistic and conceptual elements in analysis of semi-structured interviews. The sample consists of five participants whom had completed a 12 week DBT programme at a private hospital. Three master themes were identified, namely ‘Pre DBT: Crisis & Desperation’; ‘In-session: Belonging’; and ‘The Real World: Living’. Each master theme was characterised by 4 sub-themes, illustrating the journey of the participants and the perceived process of change. All themes were conceptualised by the overarching theme ‘The private setting: Heterotopia’, giving voice to the role of the context of the private psychiatric setting. The research findings illustrate that this version of DBT was a helpful and positive experience for participants, where outcomes included being able to build a life worth living, feel hope and joy, build DBT skills into a lifestyle, connect with a sense of spirituality and develop reflective practice. The implications for service delivery and for Counselling Psychology are discussed, along with ideas for future research.

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Rossiter, Rachel Cathrine. "Exploring the Experience of Dialectical Behaviour Therapists: Challenging Therapeutic Pessimism Related to Borderline Personality Disorder." University of Sydney, 2009. http://hdl.handle.net/2123/4092.

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Doctor of Health Science
The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice

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Rossiter, Rachel Cathrine. "Exploring the Experience of Dialectical Behaviour Therapists: Challenging Therapeutic Pessimism Related to Borderline Personality Disorder." Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/4092.

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The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice

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49

Eklund, Rimsten Anders, and Mats Larsson. ""Det ger sig självt om man är en bra terapeut". En intervjustudie av hemuppgifter i familjeterapi." Thesis, Linköpings universitet, Avdelningen för kliniska vetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-114905.

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Hemuppgiften är ett viktigt moment inom såväl Funktionell familjeterapi (FFT) som Dialektisk beteendeterapi (DBT). Målsättningen med denna uppsats var att utröna om, och i sådana fall på vilket sätt, hemuppgifter ges inom den familjeterapeutiska kontext som utgör ramen för FFT. En hypotes vid arbetets ingång var att de interaktionistiska hemuppgifterna kommit att ersättas av de mer beteendeorienterade som ingår i DBT. De personer som utgjort underlag för undersökningen arbetar alla på en öppenvårdsmottagning inom Barn- och ungdomspsykiatrin (BUP) i Uppsala, med antingen ovan nämnda Funktionella familjeterapi (n=3) eller med Dialektisk beteendeterapi (n=2). Syftet med studien var att, dels via en enkätundersökning dels via en intervju i fokusgruppform, försöka förstå mer av det psykoterapeutiska redskap som utgörs av hemuppgiften. Fokus låg på den relationella hemuppgift som familjeterapeuterna tillhörande nämnda team förväntas konstruera utifrån tillhandahållen FFT-manual. Resultatet visade på en relativt stor bredd när det gällde terapeuternas syn på och tillämpning av hemuppgiften, men det generella mönstret pekade på att terapeuterna i sitt praktiska arbete konstruerade såväl relationella som beteendeorienterade hemuppgifter. Vad som framkom är dock ett behov av och en önskan från familjeterapeuternas sida om en större tydlighet kring hur man går tillväga då man fastställer och ger en familj en relationellt orienterad hemuppgift. Det vi sluter oss till i vår uppsats är att ett sådant förtydligande inte låter sig göras med mindre än att man går till botten med och definierar vad funktionen av relationen innebär samt hur man använder sig av denna vid det som inom Funktionell familjeterapi kallas för relationsbedömningen.
The homework is an important part of both Functional Family Therapy (FFT) and Dialectical Behavior Therapy (DBT). The goal of this essay has been to determine if, and in what way, homework is used in the context of family therapy, that is the frame of FFT. One hypothesis at the beginning of this work was that the interactional home assignments have started to be replaced by the behavior oriented ones that are a part of DBT. The individuals participating in the study are all working in a psychiatric outpatient clinic (BUP) in Uppsala. They are all using either Functional Family Therapy (n=3) or Dialectical Behavior Therapy (n=2) as treatment methods. The purpose of the study has been to try to understand more of the homework as a therapeutic instrument, especially the relational homework that family therapists are expected to work out on the basis of a manual that is provided within FFT. Two methods have been used to examine this: a survey and focus group interview. The results show a relatively large width when it comes to the therapists view on and practice of homework, though the general pattern indicates that they work out both relational as well as behavior oriented assignments in their practical work. However, there is a need and a wish of the family therapists to gain more clarity on how to determine and give a family a relational oriented homework. The conclusion of this essay is that a clarification like that is not possible, unless you go to the bottom with and define what the relational function is and how to use it in what within Functional Family Therapy is called the Relational Assessment Phase.

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Maher, Helena P. M. "An investigation of emotional expressiveness as one of the proposed mechanisms of change of radically-open dialectical behaviour therapy." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/425921/.

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A systematic review of the literature was conducted to explore Emotional Expressiveness in Depression, 11 eligible papers were identified. Papers were critically evaluated with the research question in mind: ‘What empirical evidence is there that patients with depression are less emotionally expressive than non-depressed individuals?’ All 11 papers supported the research question that individuals with depression are less emotionally expressive, in comparison to non-depressed individuals. To the best of the author’s knowledge, no previous review has been conducted on emotional expressiveness and depression. The research available to date is in its infancy and several limitations of the studies have been delineated in this review. Thus, conclusions are tentative at best. The empirical study in this thesis investigated Emotional Expressiveness as one of the Proposed Mechanisms of Change of Radically open-Dialectical Behaviour Therapy (RO-DBT). Depression is considered to be one of the leading causes of disability today, with more than 300 million suffers world-wide (WHO, 2017, 2012). Treatment options for mild to moderate depression have proved to be efficient. However, individuals with more complex trajectories appear to be resistant to both pharmacological and psychological interventions currently available. Thus, many patients present to us clinically with chronic treatment resistant depression. RO-DBT is a transdiagnostic treatment approach that specifically set out to treat patients with complex presentations. It posits that one of the main impairments in these populations is their deficits in emotional expressiveness, which leads to exacerbation of symptoms of depression and functions as a maintenance factor of the disorder. The main objective of the current study was to explore one of the likely mechanisms of change in RO-DBT, namely, a change in emotional expressiveness as a possible result of the therapy. It was hypothesised that individuals’ observed and self-reported emotional expressiveness would become less maladaptive after receiving RO-DBT. Mental well-being would increase and ambivalence over expressing emotion and observed maladaptive social signalling would decrease, as measured by the PhQ-9, ‘Maladaptive Social Signalling scale’, and the AEQ. 30 participants’ that took part in the original RCT REFRAMED study (14 Male; 16 female, n=30) were eligible according to the inclusion/exclusion criteria for the study. Video-recordings from the RO-DBT session (Pre, Mid, Post) were viewed and rated for emotional expressiveness and scores for the three different time points on the PHQ-9 and AEQ were analysed. A cross-sectional design was utilised and a repeated measures MANOVA yielded a statistically significant result across different time points of therapy (Pre, Mid, Post). Our results provide some support for the efficacy of RODBT therapy, to reduce maladaptive social signalling behaviours, increase mental well-being and ambivalence over expressing emotions. However, there are several limitations of the study and results should therefore be interpreted with caution.

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Dissertations / Theses on the topic 'Dialectical behavior therapy'

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