1 2002 the behavioral technology transfer group (bttg) slides provided courtesy of bttg dialectical...
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12002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Dialectical Behavior Dialectical Behavior Therapy Presentation Therapy Presentation
Materials Materials
The Behavioral Technology Transfer GroupThe Behavioral Technology Transfer Group4556 University Way NE 4556 University Way NE Seattle, WA 98105 Seattle, WA 98105
PhonePhone 206/675-8588 206/675-8588 FaxFax 206/675-8590 206/675-8590
Web: www.behavioraltech.com [email protected]
Dialectical Behavior Dialectical Behavior Therapy Presentation Therapy Presentation
Materials Materials
The Behavioral Technology Transfer GroupThe Behavioral Technology Transfer Group4556 University Way NE 4556 University Way NE Seattle, WA 98105 Seattle, WA 98105
PhonePhone 206/675-8588 206/675-8588 FaxFax 206/675-8590 206/675-8590
Web: www.behavioraltech.com [email protected]
22002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Dialectical Dialectical Behavior TherapyBehavior Therapy
(DBT)(DBT)
The BasicsThe Basics
32002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Theory of Theory of Borderline Borderline
Personality Disorder Personality Disorder in DBTin DBT
42002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
BPD is a Pervasive Disorder of BPD is a Pervasive Disorder of the Emotion Regulation Systemthe Emotion Regulation System BPD is a Pervasive Disorder of BPD is a Pervasive Disorder of the Emotion Regulation Systemthe Emotion Regulation System
BPD criterion behaviors function BPD criterion behaviors function to regulate emotions orto regulate emotions or
are a natural consequence of are a natural consequence of emotion dysregulationemotion dysregulation
BPD criterion behaviors function BPD criterion behaviors function to regulate emotions orto regulate emotions or
are a natural consequence of are a natural consequence of emotion dysregulationemotion dysregulation
52002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Biosocial Theory of BPDBiosocial Theory of BPD Biosocial Theory of BPDBiosocial Theory of BPD
Pervasive Emotion DysregulationPervasive Emotion DysregulationPervasive Emotion DysregulationPervasive Emotion Dysregulation
Biological Dysfunction in the Biological Dysfunction in the Emotion Regulation SystemEmotion Regulation System
Biological Dysfunction in the Biological Dysfunction in the Emotion Regulation SystemEmotion Regulation System
Invalidating Invalidating EnvironmentEnvironmentInvalidating Invalidating EnvironmentEnvironment
62002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Emotion DysregulationEmotion DysregulationEmotion DysregulationEmotion Dysregulation
Inability to Inability to Modulate EmotionsModulate Emotions
Inability to Inability to Modulate EmotionsModulate Emotions
Emotional VulnerabilityEmotional VulnerabilityEmotional VulnerabilityEmotional Vulnerability
72002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Tasks in Emotion ModulationTasks in Emotion ModulationTasks in Emotion ModulationTasks in Emotion Modulation
*Decrease or Increase physiological arousal*Decrease or Increase physiological arousal associated with emotion associated with emotion
**Re-orient attention**Re-orient attention
***Inhibit mood-dependent action***Inhibit mood-dependent action
****Organize behavior in the ****Organize behavior in the service of external non- service of external non-
mood dependent goals mood dependent goals
82002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Invalidating EnvironmentInvalidating EnvironmentInvalidating EnvironmentInvalidating Environment
Pervasively Pervasively negates negates or or dismissesdismisses behavior behavior
independent of independent of the actual validity the actual validity
of the behaviorof the behavior
Pervasively Pervasively negates negates or or dismissesdismisses behavior behavior
independent of independent of the actual validity the actual validity
of the behaviorof the behavior
92002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT DBT is designed for the is designed for the severe and severe and
chronic multi-diagnosticchronic multi-diagnostic, , difficult-to-treat patientdifficult-to-treat patient
with both Axis I with both Axis I and Axis IIand Axis II disorders disorders
102002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
ChangeChange
CoreCore
Problem Solving
Problem Solving
AcceptanceAcceptance
ValidationValidation
Team Consultation
Team Consultation
ReciprocalReciprocalReciprocalReciprocal
Environmental Intervention
Environmental Intervention
Consultation-to-the-PatientConsultation-to-the-Patient
IrreverentIrreverentIrreverentIrreverent
112002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Balance Core StrategiesBalance Core StrategiesBalance Core StrategiesBalance Core Strategies
Dialectics
VALIDATIONVALIDATION
12
Dialectical Philosophy Dialectical Philosophy of Treatmentof Treatment
Dialectical Philosophy Dialectical Philosophy of Treatmentof Treatment
Dialectics As...Dialectics As... PersuasionPersuasion
World ViewWorld View
Dialectics As...Dialectics As... PersuasionPersuasion
World ViewWorld View
132002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Dialectics as PersuasionDialectics as PersuasionDialectics as PersuasionDialectics as Persuasion
A method of logic or argumentation A method of logic or argumentation
by disclosing the contradictions by disclosing the contradictions
(antithesis)(antithesis) in an opponent’s in an opponent’s
argument argument (thesis)(thesis) and overcoming and overcoming
them them (synthesis)(synthesis)..
A method of logic or argumentation A method of logic or argumentation
by disclosing the contradictions by disclosing the contradictions
(antithesis)(antithesis) in an opponent’s in an opponent’s
argument argument (thesis)(thesis) and overcoming and overcoming
them them (synthesis)(synthesis)..
142002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Translating a Dialectical World ViewTranslating a Dialectical World Viewinto Treatmentinto Treatment
Translating a Dialectical World ViewTranslating a Dialectical World Viewinto Treatmentinto Treatment
Provides foundation of biosocial etiology1. Transactional development and maintenance2. Systemic disorder
Dialectically informs treatment strategies1. Balance of Acceptance vs. Change2. Search for "what is left out"3. Emphasis on speed, movement, flow
Dialectically informs treatment goals1. Emotion regulation2. Interpersonal effectiveness3. Mindfulness4. Distress tolerance
Provides foundation of biosocial etiology1. Transactional development and maintenance2. Systemic disorder
Dialectically informs treatment strategies1. Balance of Acceptance vs. Change2. Search for "what is left out"3. Emphasis on speed, movement, flow
Dialectically informs treatment goals1. Emotion regulation2. Interpersonal effectiveness3. Mindfulness4. Distress tolerance
152002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Structure the Structure the Goals of TreatmentGoals of Treatment
DBT Structures Treatment GoalsDBT Structures Treatment Goals by Levels of Disorder by Levels of Disorder
Structure the Structure the Goals of TreatmentGoals of Treatment
DBT Structures Treatment GoalsDBT Structures Treatment Goals by Levels of Disorder by Levels of Disorder
162002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Structure the Structure the Primary TargetsPrimary Targets
of Treatment of Treatment
DBT arranges targets DBT arranges targets hierarchically by importance and hierarchically by importance and
grouped by level of patient grouped by level of patient disorderdisorder
Structure the Structure the Primary TargetsPrimary Targets
of Treatment of Treatment
DBT arranges targets DBT arranges targets hierarchically by importance and hierarchically by importance and
grouped by level of patient grouped by level of patient disorderdisorder
172002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Goals of Treatment by Level of DisorderGoals of Treatment by Level of Disorder Goals of Treatment by Level of DisorderGoals of Treatment by Level of Disorder
Dialectical SynthesisDialectical SynthesisLevel 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol
Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & Unhappiness Ordinary Happiness & Unhappiness
Level 4: IncompletenessLevel 4: Incompleteness
Capacity for Joy and FreedomCapacity for Joy and Freedom
Dialectical SynthesisDialectical SynthesisLevel 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol
Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & Unhappiness Ordinary Happiness & Unhappiness
Level 4: IncompletenessLevel 4: Incompleteness
Capacity for Joy and FreedomCapacity for Joy and Freedom
182002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DecreaseDecrease• Life-threatening behaviorsLife-threatening behaviors• Therapy-interfering behaviorsTherapy-interfering behaviors• Quality-of-life interfering behaviorsQuality-of-life interfering behaviors
IncreaseIncrease behavioral skillsbehavioral skills Core MindfulnessCore MindfulnessDistress ToleranceDistress ToleranceInterpersonal EffectivenessInterpersonal EffectivenessEmotion Regulation Emotion Regulation Self-ManagementSelf-Management
DecreaseDecrease• Life-threatening behaviorsLife-threatening behaviors• Therapy-interfering behaviorsTherapy-interfering behaviors• Quality-of-life interfering behaviorsQuality-of-life interfering behaviors
IncreaseIncrease behavioral skillsbehavioral skills Core MindfulnessCore MindfulnessDistress ToleranceDistress ToleranceInterpersonal EffectivenessInterpersonal EffectivenessEmotion Regulation Emotion Regulation Self-ManagementSelf-Management
Stage 1 Primary TargetsStage 1 Primary Targets Dialectical SynthesisDialectical Synthesis Severe Behavioral DyscontrolSevere Behavioral Dyscontrol Behavioral ControlBehavioral Control
Stage 1 Primary TargetsStage 1 Primary Targets Dialectical SynthesisDialectical Synthesis Severe Behavioral DyscontrolSevere Behavioral Dyscontrol Behavioral ControlBehavioral Control
19
StructureStructure the Milieu and Modes the Milieu and Modes
of Treatment of Treatment
StructureStructure the Milieu and Modes the Milieu and Modes
of Treatment of Treatment
Standard DBT is Standard DBT is Outpatient Outpatient TreatmentTreatment
Standard DBT is Standard DBT is Outpatient Outpatient TreatmentTreatment
20
STANDARD DBT isSTANDARD DBT is....STANDARD DBT isSTANDARD DBT is....
FLEXIBLEFLEXIBLE
COMPREHENSIVECOMPREHENSIVE
PRINCIPLE-DRIVENPRINCIPLE-DRIVEN
FLEXIBLEFLEXIBLE
COMPREHENSIVECOMPREHENSIVE
PRINCIPLE-DRIVENPRINCIPLE-DRIVEN
212002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Standard DBT ModesStandard DBT ModesStandard DBT ModesStandard DBT Modes Outpatient Individual PsychotherapyOutpatient Individual Psychotherapy Outpatient Group Skills TrainingOutpatient Group Skills Training Telephone ConsultationTelephone Consultation Therapists’ Consultation MeetingTherapists’ Consultation Meeting Uncontrolled Ancillary TreatmentsUncontrolled Ancillary Treatments
• PharmacotherapyPharmacotherapy• Acute-Inpatient PsychiatricAcute-Inpatient Psychiatric
Outpatient Individual PsychotherapyOutpatient Individual Psychotherapy Outpatient Group Skills TrainingOutpatient Group Skills Training Telephone ConsultationTelephone Consultation Therapists’ Consultation MeetingTherapists’ Consultation Meeting Uncontrolled Ancillary TreatmentsUncontrolled Ancillary Treatments
• PharmacotherapyPharmacotherapy• Acute-Inpatient PsychiatricAcute-Inpatient Psychiatric
222002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Five Functions of Five Functions of Comprehensive TreatmentComprehensive Treatment
Five Functions of Five Functions of Comprehensive TreatmentComprehensive Treatment
1.1. Enhance capabilities Enhance capabilities
2.2. Improve motivational factors Improve motivational factors
3. 3. Assure generalization to natural Assure generalization to natural environment environment
4.4. Enhance therapist capabilities and Enhance therapist capabilities and motivation to treat effectively motivation to treat effectively
5. 5. Structure the environmentStructure the environment
1.1. Enhance capabilities Enhance capabilities
2.2. Improve motivational factors Improve motivational factors
3. 3. Assure generalization to natural Assure generalization to natural environment environment
4.4. Enhance therapist capabilities and Enhance therapist capabilities and motivation to treat effectively motivation to treat effectively
5. 5. Structure the environmentStructure the environment
232002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
The Overarching
DBT GoalGoal is...is...
The Overarching
DBT GoalGoal is...is...
24
Treatments for BPD:Treatments for BPD:• Pharmacotherapy Pharmacotherapy
• Object Relations Partial Object Relations Partial Hospitalization Hospitalization
• DBTDBT
Treatments for BPD:Treatments for BPD:• Pharmacotherapy Pharmacotherapy
• Object Relations Partial Object Relations Partial Hospitalization Hospitalization
• DBTDBT
252002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
PharmacotherapyPharmacotherapy
26
Pharmacotherapy Pharmacotherapy Treatments for BPD: Treatments for BPD: Paul Soloff, MDPaul Soloff, MDSoloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23 (1), 169-92.
Medications Algorithm & RulesMedications Algorithm & Rules–Target specific problem areaTarget specific problem area
•Cognitive/perceptualCognitive/perceptual•AffectiveAffective•Impulsive dyscontrolImpulsive dyscontrol
–Strong empirical supportStrong empirical support–Safe Safe –Act rapidlyAct rapidly
Pharmacotherapy Pharmacotherapy Treatments for BPD: Treatments for BPD: Paul Soloff, MDPaul Soloff, MDSoloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23 (1), 169-92.
Medications Algorithm & RulesMedications Algorithm & Rules–Target specific problem areaTarget specific problem area
•Cognitive/perceptualCognitive/perceptual•AffectiveAffective•Impulsive dyscontrolImpulsive dyscontrol
–Strong empirical supportStrong empirical support–Safe Safe –Act rapidlyAct rapidly
272002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Soloff’s Medication Soloff’s Medication Algorithm: Algorithm: Treating Cognitive/Perceptual Symptoms Treating Cognitive/Perceptual Symptoms
Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23 (1), 169-92.
START with low-dose typical neurolepticSTART with low-dose typical neuroleptic
If poor/partial response, INCREASE dose.If poor/partial response, INCREASE dose.
If response still poor, RECONSIDER DIAGNOSIS. If response still poor, RECONSIDER DIAGNOSIS. If symptoms are mood congruent, treat for affective If symptoms are mood congruent, treat for affective symptoms.symptoms.
If symptoms do NOT have a major mood component, If symptoms do NOT have a major mood component, SWITCH to clozapine or another atypical anti-SWITCH to clozapine or another atypical anti-psychotic.psychotic.
282002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Soloff’s Medication Soloff’s Medication Algorithm: Algorithm: Treating Affective SymptomsTreating Affective Symptoms
Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23 (1), 169-92.
START with SSRI or related and antidepressant.START with SSRI or related and antidepressant. If response inadequate, SWITCH to different SSRI If response inadequate, SWITCH to different SSRI
or related antidepressant.or related antidepressant. If response still poor, AUGMENT with a If response still poor, AUGMENT with a
benzodiazepine or a low-dose neuroleptic.benzodiazepine or a low-dose neuroleptic. If response remains inadequate, SWITCH to If response remains inadequate, SWITCH to
MAOI.MAOI. FINALLY, add/switch to lithium or a mood FINALLY, add/switch to lithium or a mood
stabilizer.stabilizer.
292002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Soloff’s Medication Soloff’s Medication Algorithm: Algorithm: Treating Impulsive Symptoms Treating Impulsive Symptoms
Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23 (1), 169-92.
START with SSRI (if rapid response is needed, a low-START with SSRI (if rapid response is needed, a low-dose conventional neuroleptic).dose conventional neuroleptic).
If response to SSRI monotherapy inadequate, If response to SSRI monotherapy inadequate, ADD/SWITCH to low-dose neuroleptic.ADD/SWITCH to low-dose neuroleptic.
If response remains poor, ADD/SWITCH to lithium If response remains poor, ADD/SWITCH to lithium or MAOI.or MAOI.
SWITCH to carbamazepine or valproate, if no SWITCH to carbamazepine or valproate, if no response.response.
If necessary, ADD atypical neuroleptic.If necessary, ADD atypical neuroleptic.
302002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Consensus By Experts on Consensus By Experts on Pharmacotherapy for BPDPharmacotherapy for BPD
No “magic bullet” medication for BPD No “magic bullet” medication for BPD patientspatients
Soloff’s algorithm is method of choice Soloff’s algorithm is method of choice where drugs target domain of dysfunction.where drugs target domain of dysfunction.
Pharmacotherapy alone is insufficient to Pharmacotherapy alone is insufficient to treat BPD; must be combined with treat BPD; must be combined with psychosocial treatment.psychosocial treatment.
312002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Object RelationsObject Relations
322002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Bateman & Fonagy’s 18-monthBateman & Fonagy’s 18-monthPartial Hospitalization Program (PHP)Partial Hospitalization Program (PHP)
PHP Treatment:PHP Treatment:• 3x/week group psychotherapy3x/week group psychotherapy• 1x/week individual psychotherapy, expressive 1x/week individual psychotherapy, expressive
therapy, and community meetingtherapy, and community meeting• 1x/month meeting with psychiatrist and case 1x/month meeting with psychiatrist and case
administratoradministratorControl: Standard Psychiatric CareControl: Standard Psychiatric Care
• 2x/month meeting with psychiatrist and 2x/month meeting with psychiatrist and visiting psychiatric nursevisiting psychiatric nurse
332002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Bateman & Fonagy’s 18-monthBateman & Fonagy’s 18-monthPartial Hospitalization Program (PHP)Partial Hospitalization Program (PHP)
PHP<ControlPHP<Control• Frequency of suicide attempts and self-Frequency of suicide attempts and self-
mutilationmutilation• Number and duration of inpatient admissionsNumber and duration of inpatient admissions• Use of psychotropic medicationsUse of psychotropic medications• Self-report measures of depression, anxietySelf-report measures of depression, anxiety
PHP>ControlPHP>Control• Improvements on self-report measures of Improvements on self-report measures of
social and interpersonal functioningsocial and interpersonal functioning
342002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Critique of Bateman & Fonagy’s PHPCritique of Bateman & Fonagy’s PHP
1. Methodological Confounds1. Methodological Confounds• PHP patients received considerably more treatment per PHP patients received considerably more treatment per
week (6+ hours) compared to TAU (3 hours/month).week (6+ hours) compared to TAU (3 hours/month).
2. No treatment manual currently exists2. No treatment manual currently exists limiting further investigation by others. limiting further investigation by others.
3. No studies have replicated original3. No studies have replicated original findings. findings.
4. PHP may be more expensive than DBT. 4. PHP may be more expensive than DBT. • (18 months vs. 12 months; PHP vs. outpatient).(18 months vs. 12 months; PHP vs. outpatient).
352002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBTDBT
362002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT Randomized DBT Randomized Controlled TrialsControlled Trials
Linehan, et. al. study Linehan, et. al. study of chronically suicidal of chronically suicidal patients with BPD patients with BPD (1991, 1992, 1993, 1994).(1991, 1992, 1993, 1994).
Koons, Robins et al. Koons, Robins et al. study of BPD women study of BPD women in VA setting in VA setting (2001).(2001).
Linehan, et al. study Linehan, et al. study of drug-dependent of drug-dependent women with BPD women with BPD (1999).(1999).
Linehan, et al. study Linehan, et al. study of heroin-addicted of heroin-addicted BPD women BPD women (2002).(2002).
372002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Randomized Controlled Trial: DBT vs. Treatment-as-Usual
With Chronically Suicidal BPD Women
(University of Washington)
Linehan, et al., 1991, 1992, 1993, 1994
Randomized Controlled Trial: DBT vs. Treatment-as-Usual
With Chronically Suicidal BPD Women
(University of Washington)
Linehan, et al., 1991, 1992, 1993, 1994
382002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT < TAUDBT < TAU DBT < TAUDBT < TAU % with parasuicide% with parasuicide # parasuicides# parasuicides medical risk of parasuicidemedical risk of parasuicide treatment drop-outstreatment drop-outs psychiatric inpatient dayspsychiatric inpatient days angeranger
% with parasuicide% with parasuicide # parasuicides# parasuicides medical risk of parasuicidemedical risk of parasuicide treatment drop-outstreatment drop-outs psychiatric inpatient dayspsychiatric inpatient days angeranger
DBT > TAUDBT > TAU DBT > TAUDBT > TAU social adjustmentsocial adjustment global adjustmentglobal adjustment
392002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DepressionDepression HopelessnessHopelessness Suicide ideationSuicide ideation
DepressionDepression HopelessnessHopelessness Suicide ideationSuicide ideation
Pre-treatment > 12-monthPre-treatment > 12-monthPre-treatment > 12-monthPre-treatment > 12-month
DBT vs. TAU: nsDBT vs. TAU: ns DBT vs. TAU: nsDBT vs. TAU: ns
402002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Efficiency & CostsEfficiency & CostsOf DBT v. TAUOf DBT v. TAU
Cost for DBT is about 50% of TAUCost for DBT is about 50% of TAU
• Significantly fewer inpatient daysSignificantly fewer inpatient days
• Fewer and less severe parasuicidal Fewer and less severe parasuicidal behaviorsbehaviors
• Fewer emergency medical visitsFewer emergency medical visits
• Less therapy dropoutLess therapy dropout
412002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. Treatment-as-Usual DBT vs. Treatment-as-Usual for BPDfor BPD
(Durham VA Medical Center)(Durham VA Medical Center)
Koons, Robins, et al. , 2001Koons, Robins, et al. , 2001
DBT vs. Treatment-as-Usual DBT vs. Treatment-as-Usual for BPDfor BPD
(Durham VA Medical Center)(Durham VA Medical Center)
Koons, Robins, et al. , 2001Koons, Robins, et al. , 2001
422002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Design: RCTDesign: RCTDesign: RCTDesign: RCT
Conditions: Dialectical Behavior Therapy (DBT)
Treatment-as-Usual (TAU)
Time Frame: 6-month treatment
Assessments: Pre-treatmentMid-treatment (3 months)
Post-treatment (6 months)
Conditions: Dialectical Behavior Therapy (DBT)
Treatment-as-Usual (TAU)
Time Frame: 6-month treatment
Assessments: Pre-treatmentMid-treatment (3 months)
Post-treatment (6 months)
432002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
SubjectsSubjectsSubjectsSubjects Women veterans, total N = 20Women veterans, total N = 20 BPD on SCID-IIBPD on SCID-II Mean Age = 35Mean Age = 35 Lifetime history of parasuicide = 75%Lifetime history of parasuicide = 75% Parasuicide within 6 months = 40%Parasuicide within 6 months = 40% Overall, a less parasuicidal, less frequently Overall, a less parasuicidal, less frequently
hospitalized group than studied in Linehan’s hospitalized group than studied in Linehan’s (1991) study.(1991) study.
Women veterans, total N = 20Women veterans, total N = 20 BPD on SCID-IIBPD on SCID-II Mean Age = 35Mean Age = 35 Lifetime history of parasuicide = 75%Lifetime history of parasuicide = 75% Parasuicide within 6 months = 40%Parasuicide within 6 months = 40% Overall, a less parasuicidal, less frequently Overall, a less parasuicidal, less frequently
hospitalized group than studied in Linehan’s hospitalized group than studied in Linehan’s (1991) study.(1991) study.
442002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT < TAU at Post-TreatmentDBT < TAU at Post-Treatment DBT < TAU at Post-TreatmentDBT < TAU at Post-Treatment
# parasuicides (<.10)# parasuicides (<.10)
Suicide IdeationSuicide Ideation
Depression (BDI)Depression (BDI)
HopelessnessHopelessness
Anger OutAnger Out
# parasuicides (<.10)# parasuicides (<.10)
Suicide IdeationSuicide Ideation
Depression (BDI)Depression (BDI)
HopelessnessHopelessness
Anger OutAnger Out
452002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Reduction in Mean Number of Reduction in Mean Number of Parasuicide Acts Over Time for Each Parasuicide Acts Over Time for Each
Condition Analyzed SeparatelyCondition Analyzed Separately
5.1
0.65
1.61.1
0.4
1
0
1
2
3
4
5
6
Mean Number
Pre-Treatment Mid-Treatment Post-Treatment
Time
DBT*
TAU
* p<.10* p<.10
Koons, Robins, et al. (1998)
462002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. Treatment-as-UsualDBT vs. Treatment-as-UsualWith BPD Substance AbusersWith BPD Substance Abusers
(University of Washington)(University of Washington)
Linehan, Schmidt, Dimeff, Kanter, Craft, Linehan, Schmidt, Dimeff, Kanter, Craft, Comtois, McDavid, 1999Comtois, McDavid, 1999
DBT vs. Treatment-as-UsualDBT vs. Treatment-as-UsualWith BPD Substance AbusersWith BPD Substance Abusers
(University of Washington)(University of Washington)
Linehan, Schmidt, Dimeff, Kanter, Craft, Linehan, Schmidt, Dimeff, Kanter, Craft, Comtois, McDavid, 1999Comtois, McDavid, 1999
472002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
17
Design: RCTDesign: RCTDesign: RCTDesign: RCTConditionsConditions:: DBTDBT
Treatment-as-Usual (TAU)Treatment-as-Usual (TAU)
Time FrameTime Frame:: 1 year treatment1 year treatment 4 month follow-up4 month follow-up
AssessmentsAssessments:: Pre-treatmentPre-treatment4 month4 month8 month8 month12 month 12 month (post-treatment)(post-treatment)
16 month16 month
ConditionsConditions:: DBTDBT Treatment-as-Usual (TAU)Treatment-as-Usual (TAU)
Time FrameTime Frame:: 1 year treatment1 year treatment 4 month follow-up4 month follow-up
AssessmentsAssessments:: Pre-treatmentPre-treatment4 month4 month8 month8 month12 month 12 month (post-treatment)(post-treatment)
16 month16 month
482002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subjects: n=28Subjects: n=28Subjects: n=28Subjects: n=28 BPDBPD
SUD for opiates, cocaine, amphetamines, SUD for opiates, cocaine, amphetamines, sedatives, hypnotics, or anxiolytics sedatives, hypnotics, or anxiolytics oror Polysubstance Use DisorderPolysubstance Use Disorder
FemaleFemale Did not meet criteria for:Did not meet criteria for:
• Schizophrenia or other Psychotic DisorderSchizophrenia or other Psychotic Disorder• Bipolar DisorderBipolar Disorder• Mental RetardationMental Retardation
BPDBPD
SUD for opiates, cocaine, amphetamines, SUD for opiates, cocaine, amphetamines, sedatives, hypnotics, or anxiolytics sedatives, hypnotics, or anxiolytics oror Polysubstance Use DisorderPolysubstance Use Disorder
FemaleFemale Did not meet criteria for:Did not meet criteria for:
• Schizophrenia or other Psychotic DisorderSchizophrenia or other Psychotic Disorder• Bipolar DisorderBipolar Disorder• Mental RetardationMental Retardation
492002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Matching VariablesMatching VariablesMatching VariablesMatching Variables
AgeAge
Severity of Highest Drug Severity of Highest Drug DependenceDependence
Readiness to ChangeReadiness to Change
Global Adjustment (Axis V, Global Adjustment (Axis V, DSM-IV)DSM-IV)
AgeAge
Severity of Highest Drug Severity of Highest Drug DependenceDependence
Readiness to ChangeReadiness to Change
Global Adjustment (Axis V, Global Adjustment (Axis V, DSM-IV)DSM-IV)
502002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Proportion of Urinalyses Proportion of Urinalyses DIRTYDIRTY by Conditionby Condition
Proportion of Urinalyses Proportion of Urinalyses DIRTYDIRTY by Conditionby Condition
47.640.1
33.5
57.1
47.545.5
70.466.4 66
84.3
0
10
20
30
40
50
60
70
80
90
100
Pre-tx 4- Month***
8- Month*
12- Month
16-Month**
DBT
TAU
Mean Proportion
Dirty
Mean Proportion
Dirty
TimeTime* p<.10**p<.05***p<.01
* p<.10**p<.05***p<.01
512002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Interviewer-Assessed Proportion of Interviewer-Assessed Proportion of DAYS DAYS USINGUSING Drugs and Alcohol by Condition Drugs and Alcohol by Condition
Interviewer-Assessed Proportion of Interviewer-Assessed Proportion of DAYS DAYS USINGUSING Drugs and Alcohol by Condition Drugs and Alcohol by Condition
611
2118
71
68 54
4438 40
0
10
20
30
40
50
60
70
80
Pre-tx 4- Month***
8- Month**
12- Month*
16- Month***
DBT
TAU
TimeTime
* p<.10**p<.05***p<.02
* p<.10**p<.05***p<.02
Proportion of Days
Using
Proportion of Days
Using
522002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Percent Treatment Drop-OutsPercent Treatment Drop-OutsPercent Treatment Drop-OutsPercent Treatment Drop-Outs
42
81
0
50
100
DBT
TAUp<.05
532002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Mean Number of Treatment Sessions Mean Number of Treatment Sessions During the Year by ConditionDuring the Year by Condition
Mean Number of Treatment Sessions Mean Number of Treatment Sessions During the Year by ConditionDuring the Year by Condition
42.4
16.6
43.1
31.6
DBT
TAU
Psychotherapy Sessions +
Counseling with a Case Manager
Individual Psychotherapy
Sessions*
* p<.05* p<.05
542002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT < TAUDBT < TAU Drug use
DBT > TAUDBT > TAU Global Adjustment (at 16-month) Social Adjustment (at 16-month)
DBT gains continued at follow-up
DBT vs. TAU: nsDBT vs. TAU: ns•Parasuicide Episodes• Anger
DBT < TAUDBT < TAU Drug use
DBT > TAUDBT > TAU Global Adjustment (at 16-month) Social Adjustment (at 16-month)
DBT gains continued at follow-up
DBT vs. TAU: nsDBT vs. TAU: ns•Parasuicide Episodes• Anger
552002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. Comprehensive Validation DBT vs. Comprehensive Validation (1 Year)(1 Year)
with BPD Heroin Addictswith BPD Heroin Addicts
University of WashingtonUniversity of Washington
Linehan, Dimeff, Reynolds, Comtois, Linehan, Dimeff, Reynolds, Comtois, McDavid, & KivlahanMcDavid, & Kivlahan
DBT vs. Comprehensive Validation DBT vs. Comprehensive Validation (1 Year)(1 Year)
with BPD Heroin Addictswith BPD Heroin Addicts
University of WashingtonUniversity of Washington
Linehan, Dimeff, Reynolds, Comtois, Linehan, Dimeff, Reynolds, Comtois, McDavid, & KivlahanMcDavid, & Kivlahan
562002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subjects: n=23Subjects: n=23Subjects: n=23Subjects: n=23
BPD on SCID II and PDEBPD on SCID II and PDE Met criteria for Heroin DependenceMet criteria for Heroin Dependence 18-45 Years18-45 Years FemaleFemale
Did not meet criteria for:Did not meet criteria for:• Schizophrenia or other Psychotic DisorderSchizophrenia or other Psychotic Disorder• Bipolar DisorderBipolar Disorder• Mental RetardationMental Retardation
BPD on SCID II and PDEBPD on SCID II and PDE Met criteria for Heroin DependenceMet criteria for Heroin Dependence 18-45 Years18-45 Years FemaleFemale
Did not meet criteria for:Did not meet criteria for:• Schizophrenia or other Psychotic DisorderSchizophrenia or other Psychotic Disorder• Bipolar DisorderBipolar Disorder• Mental RetardationMental Retardation
572002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Matching VariablesMatching VariablesMatching VariablesMatching Variables
AgeAge
Cocaine DependenceCocaine Dependence
Anti-Social Personality DisorderAnti-Social Personality Disorder
Global Assessment of Functioning Global Assessment of Functioning (GAF)(GAF)
AgeAge
Cocaine DependenceCocaine Dependence
Anti-Social Personality DisorderAnti-Social Personality Disorder
Global Assessment of Functioning Global Assessment of Functioning (GAF)(GAF)
582002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Design: RCTDesign: RCTDesign: RCTDesign: RCTConditionsConditions:: Dialectical Behavior Therapy Dialectical Behavior Therapy
(DBT)(DBT) Comprehensive Validation Comprehensive Validation
TherapyTherapy (CVT)(CVT)
Time FrameTime Frame:: 12 month treatment12 month treatment 4 month follow-up4 month follow-up
AssessmentsAssessments:: Pre-treatmentPre-treatment 4 month4 month 8 month 8 month
12 month (post)12 month (post) 16 month16 month
ConditionsConditions:: Dialectical Behavior Therapy Dialectical Behavior Therapy (DBT)(DBT)
Comprehensive Validation Comprehensive Validation TherapyTherapy (CVT)(CVT)
Time FrameTime Frame:: 12 month treatment12 month treatment 4 month follow-up4 month follow-up
AssessmentsAssessments:: Pre-treatmentPre-treatment 4 month4 month 8 month 8 month
12 month (post)12 month (post) 16 month16 month
592002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Treatment ConditionsTreatment ConditionsTreatment ConditionsTreatment Conditions Individual TherapyIndividual Therapy Group Skills TrainingGroup Skills Training Homework ReviewHomework Review Phone CoachingPhone Coaching Therapist Consult MeetingTherapist Consult Meeting Drug-ReplacementDrug-Replacement
Individual TherapyIndividual Therapy NA 12&12 GroupNA 12&12 Group NA 12&12 SponsorNA 12&12 Sponsor Crisis InterventionCrisis Intervention Therapist Consult MeetingTherapist Consult Meeting Drug-ReplacementDrug-Replacement
Individual TherapyIndividual Therapy Group Skills TrainingGroup Skills Training Homework ReviewHomework Review Phone CoachingPhone Coaching Therapist Consult MeetingTherapist Consult Meeting Drug-ReplacementDrug-Replacement
Individual TherapyIndividual Therapy NA 12&12 GroupNA 12&12 Group NA 12&12 SponsorNA 12&12 Sponsor Crisis InterventionCrisis Intervention Therapist Consult MeetingTherapist Consult Meeting Drug-ReplacementDrug-Replacement
DBTDBTDBTDBT
CVTCVT CVTCVT
602002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
AssessmentsAssessmentsAssessmentsAssessments
• Urinalysis (3 times weekly)Urinalysis (3 times weekly)
• Substance Abuse History Substance Abuse History Interview (SAHI)Interview (SAHI)
• Urinalysis (3 times weekly)Urinalysis (3 times weekly)
• Substance Abuse History Substance Abuse History Interview (SAHI)Interview (SAHI)
612002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT
CVT+12S
Opiate Use Across YearOpiate Use Across YearOpiate Use Across YearOpiate Use Across Year%
%
Po
siti
veP
osi
tive
%
% P
osi
tive
Po
siti
ve
WeeksWeeksWeeksWeeks
622002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Percent Treatment Drop-OutsPercent Treatment Drop-OutsPercent Treatment Drop-OutsPercent Treatment Drop-Outs
36%
0%
0%5%
10%
15%20%
25%30%
35%40%
Condition
DBT
CVT
p<.05
632002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. CVT+12S: nsDBT vs. CVT+12S: nsDBT vs. CVT+12S: nsDBT vs. CVT+12S: ns
Drug Use, Self-ReportDrug Use, Self-Report Brief Symptom InventoryBrief Symptom Inventory Global AdjustmentGlobal Adjustment Social AdjustmentSocial Adjustment
Drug Use, Self-ReportDrug Use, Self-Report Brief Symptom InventoryBrief Symptom Inventory Global AdjustmentGlobal Adjustment Social AdjustmentSocial Adjustment
Pre-treatment > 12-monthPre-treatment > 12-monthPre-treatment > 12-monthPre-treatment > 12-month
642002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Integrating DBT into Integrating DBT into Community Mental HealthCommunity Mental Health
The Mental Health Center of Greater The Mental Health Center of Greater Manchester, New HampshireManchester, New Hampshire
Recipients of the 1998 Gold AwardRecipients of the 1998 Gold AwardAmerican Psychiatric AssociationAmerican Psychiatric Association
Psychiatric ServicesPsychiatric Services, , 4949, 1338-1340, 1338-1340
652002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
The Mental Health Center of Greater The Mental Health Center of Greater Manchester, New HampshireManchester, New Hampshire
Provided comprehensive DBT in outpatient Provided comprehensive DBT in outpatient setting.setting.
Pre-post data collected for first 14 patients Pre-post data collected for first 14 patients receiving DBT.receiving DBT.
Team received intensive 10-day training in Team received intensive 10-day training in DBT over six month period of time.DBT over six month period of time.
662002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Treatment Costs Cut by More than HalfTreatment Costs Cut by More than HalfFrom $645,000 to $273,000From $645,000 to $273,000
77% decrease in 77% decrease in hospital days, from 479 hospital days, from 479 to 85 days.to 85 days.
76% decrease in partial 76% decrease in partial hospital days, from 173 hospital days, from 173 to 42 days.to 42 days.
56% decrease in crisis 56% decrease in crisis beds, from 170 to 73 beds, from 170 to 73 beds.beds.
80% decrease in face-80% decrease in face-to-face contact with to-face contact with emergency services, emergency services, from 61 to 12 days.from 61 to 12 days.
Significant increase in Significant increase in outpatient services, outpatient services, from 438 days to 1,387 from 438 days to 1,387 days.days.
672002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Non-Randomized Studies On DBTNon-Randomized Studies On DBT Stanley, Ivanoff et. al. Stanley, Ivanoff et. al.
Study of Suicidal, Self-Study of Suicidal, Self-Mutilators Mutilators (1998).(1998).
Miller & Rathus study of Miller & Rathus study of DBT for Suicidal DBT for Suicidal AdoelscentsAdoelscents (1996).(1996).
McCann & Ball study of McCann & Ball study of DBT for Forensic DBT for Forensic InpatientsInpatients (1996). (1996).
Bohus et al. Study of Bohus et al. Study of DBT inpatient treatment DBT inpatient treatment (2001).(2001).
Trupin et al. Study of Trupin et al. Study of incarcerated youth incarcerated youth (2002).(2002).
682002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. Treatment-as-Usual DBT vs. Treatment-as-Usual for Suicidal and for Suicidal and
Self-Mutilating BehaviorSelf-Mutilating Behavior
(New York State Psychiatric Institute(New York State Psychiatric Institute& Columbia University)& Columbia University)
Stanley, B., Ivanoff, A., Brodsky, B., & Oppenheim, Stanley, B., Ivanoff, A., Brodsky, B., & Oppenheim, S. (1998S. (1998))
DBT vs. Treatment-as-Usual DBT vs. Treatment-as-Usual for Suicidal and for Suicidal and
Self-Mutilating BehaviorSelf-Mutilating Behavior
(New York State Psychiatric Institute(New York State Psychiatric Institute& Columbia University)& Columbia University)
Stanley, B., Ivanoff, A., Brodsky, B., & Oppenheim, Stanley, B., Ivanoff, A., Brodsky, B., & Oppenheim, S. (1998S. (1998))
692002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Design: Matched ControlDesign: Matched ControlDesign: Matched ControlDesign: Matched ControlConditionsConditions:: Dialectical Behavior Therapy Dialectical Behavior Therapy
(DBT)(DBT) Treatment-as-Usual (TAU)Treatment-as-Usual (TAU)
Time FrameTime Frame:: 6-month treatment6-month treatment
AssessmentsAssessments::Pre-treatmentPre-treatmentMid-treatment (3 months)Mid-treatment (3 months)Post-treatmentPost-treatment
ConditionsConditions:: Dialectical Behavior Therapy Dialectical Behavior Therapy (DBT)(DBT)
Treatment-as-Usual (TAU)Treatment-as-Usual (TAU)
Time FrameTime Frame:: 6-month treatment6-month treatment
AssessmentsAssessments::Pre-treatmentPre-treatmentMid-treatment (3 months)Mid-treatment (3 months)Post-treatmentPost-treatment
702002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subjects: n = 30Subjects: n = 30Subjects: n = 30Subjects: n = 30
BPDBPD FemalesFemales ParasuicidalParasuicidal The baseline mean number of suicide The baseline mean number of suicide
attempts did not differ between DBT attempts did not differ between DBT
and TAUand TAU
BPDBPD FemalesFemales ParasuicidalParasuicidal The baseline mean number of suicide The baseline mean number of suicide
attempts did not differ between DBT attempts did not differ between DBT
and TAUand TAU
712002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT < TAUDBT < TAU
DBT < TAUDBT < TAU
• Self-mutilationSelf-mutilation• Suicide ideationSuicide ideation• Suicidal urgesSuicidal urges• Urges to self-mutilateUrges to self-mutilate
• Self-mutilationSelf-mutilation• Suicide ideationSuicide ideation• Suicidal urgesSuicidal urges• Urges to self-mutilateUrges to self-mutilate
(Neither group had a suicide attempt.)
(Neither group had a suicide attempt.)
722002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT = TAUDBT = TAU DBT = TAUDBT = TAU
DepressionDepression
HopelessnessHopelessness
Global AdjustmentGlobal Adjustment
DepressionDepression
HopelessnessHopelessness
Global AdjustmentGlobal Adjustment
732002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DDBT vs. Treatment-as-UsualBT vs. Treatment-as-Usualfor Suicidal Adolescents for Suicidal Adolescents
The Albert Einstein College of Medicine/The Albert Einstein College of Medicine/Montefiore Medical CenterMontefiore Medical Center
Miller, A. L. & Rathus, J. H. (1996)Miller, A. L. & Rathus, J. H. (1996)
DDBT vs. Treatment-as-UsualBT vs. Treatment-as-Usualfor Suicidal Adolescents for Suicidal Adolescents
The Albert Einstein College of Medicine/The Albert Einstein College of Medicine/Montefiore Medical CenterMontefiore Medical Center
Miller, A. L. & Rathus, J. H. (1996)Miller, A. L. & Rathus, J. H. (1996)
742002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Design: Parallel Control GroupDesign: Parallel Control GroupDesign: Parallel Control GroupDesign: Parallel Control Group
ConditionsConditions:: DBT for AdolescentsDBT for Adolescents Treatment-as-Treatment-as-Usual Usual
Time FrameTime Frame:: 12 week treatment12 week treatment
AssessmentsAssessments:: Pre-treatmentPre-treatment
Post-treatment (12 wk)Post-treatment (12 wk)
ConditionsConditions:: DBT for AdolescentsDBT for Adolescents Treatment-as-Treatment-as-Usual Usual
Time FrameTime Frame:: 12 week treatment12 week treatment
AssessmentsAssessments:: Pre-treatmentPre-treatment
Post-treatment (12 wk)Post-treatment (12 wk)
752002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subjects: n=111 (DBT=29, TAU=82)Subjects: n=111 (DBT=29, TAU=82)Subjects: n=111 (DBT=29, TAU=82)Subjects: n=111 (DBT=29, TAU=82)
Referrals to the Adolescent Depression and Referrals to the Adolescent Depression and Suicide Program, 78% female and 22% Suicide Program, 78% female and 22% malemale
Age range 12-19 yearsAge range 12-19 years
68% Hispanic, 17% African American, 68% Hispanic, 17% African American, 8% Caucasian, 1% Asian, 6% other8% Caucasian, 1% Asian, 6% other
Referrals to the Adolescent Depression and Referrals to the Adolescent Depression and Suicide Program, 78% female and 22% Suicide Program, 78% female and 22% malemale
Age range 12-19 yearsAge range 12-19 years
68% Hispanic, 17% African American, 68% Hispanic, 17% African American, 8% Caucasian, 1% Asian, 6% other8% Caucasian, 1% Asian, 6% other
762002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subjects: Assignment to ConditionSubjects: Assignment to ConditionSubjects: Assignment to ConditionSubjects: Assignment to Condition
Subjects were assigned to DBT if they Subjects were assigned to DBT if they met the following criteria:met the following criteria:
Subjects were assigned to DBT if they Subjects were assigned to DBT if they met the following criteria:met the following criteria: Either made a suicide attempt within the Either made a suicide attempt within the
last 16 weeks OR reported current last 16 weeks OR reported current suicidal ideation suicidal ideation
Met diagnostic criteria for BPD or Met diagnostic criteria for BPD or borderline personality features (as borderline personality features (as measured by the SCID-II)measured by the SCID-II)
Either made a suicide attempt within the Either made a suicide attempt within the last 16 weeks OR reported current last 16 weeks OR reported current suicidal ideation suicidal ideation
Met diagnostic criteria for BPD or Met diagnostic criteria for BPD or borderline personality features (as borderline personality features (as measured by the SCID-II)measured by the SCID-II)
772002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT < TAUDBT < TAUDBT < TAUDBT < TAU
• Treatment drop-outTreatment drop-out• Inpatient psychiatric daysInpatient psychiatric days
• Treatment drop-outTreatment drop-out• Inpatient psychiatric daysInpatient psychiatric days
DBT = TAUDBT = TAUDBT = TAUDBT = TAU
• Suicide AttemptsSuicide Attempts
• Suicide AttemptsSuicide Attempts
782002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Treatment Drop-out: DBT vs.. Treatment Drop-out: DBT vs.. TAUTAU
Treatment Drop-out: DBT vs.. Treatment Drop-out: DBT vs.. TAUTAU
38
60
0
20
40
60
80
100
Per
cen
t D
rop
-ou
t
DBT
TAU
* p=.04* p=.04
792002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Psychiatric Hospitalizations Psychiatric Hospitalizations During Treatment: DBT vs. TAUDuring Treatment: DBT vs. TAU
Psychiatric Hospitalizations Psychiatric Hospitalizations During Treatment: DBT vs. TAUDuring Treatment: DBT vs. TAU
0
13
0
5
10
15
Per
cen
t H
osp
ital
ized
DBT
TAU
* p=.04* p=.04
802002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT=TAU: Suicide AttemptsDBT=TAU: Suicide AttemptsDBT=TAU: Suicide AttemptsDBT=TAU: Suicide AttemptsDBT>TAU at pre-treatment:DBT>TAU at pre-treatment:
•Number of Axis I disorders Number of Axis I disorders •ImpulsivityImpulsivity•Number of prior hospitalizationsNumber of prior hospitalizations
The fact that DBT subjects were The fact that DBT subjects were notnot more suicidal during treatment than more suicidal during treatment than TAU is noteworthyTAU is noteworthy..
DBT>TAU at pre-treatment:DBT>TAU at pre-treatment:•Number of Axis I disorders Number of Axis I disorders •ImpulsivityImpulsivity•Number of prior hospitalizationsNumber of prior hospitalizations
The fact that DBT subjects were The fact that DBT subjects were notnot more suicidal during treatment than more suicidal during treatment than TAU is noteworthyTAU is noteworthy..
812002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Suicide Attempts: DBT vs. TAUSuicide Attempts: DBT vs. TAUSuicide Attempts: DBT vs. TAUSuicide Attempts: DBT vs. TAU
0
9
0
2
4
6
8
10
Per
cen
t w
ith
A
ttem
pt
DBT
TAU
Miller, A. L., & Rathus, J. H. (1996)
*ns*ns
822002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. Treatment-as-UsualDBT vs. Treatment-as-Usualfor Forensic Inpatientsfor Forensic Inpatients
Institute for Forensic PsychiatryInstitute for Forensic PsychiatryColorado Mental Health Institute at PuebloColorado Mental Health Institute at Pueblo
McCann & Ball, 1996McCann & Ball, 1996
DBT vs. Treatment-as-UsualDBT vs. Treatment-as-Usualfor Forensic Inpatientsfor Forensic Inpatients
Institute for Forensic PsychiatryInstitute for Forensic PsychiatryColorado Mental Health Institute at PuebloColorado Mental Health Institute at Pueblo
McCann & Ball, 1996McCann & Ball, 1996
832002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Design: LongitudinalDesign: LongitudinalDesign: LongitudinalDesign: Longitudinal
Conditions: Dialectical Behavior Therapy (DBT; n=21)
Treatment-as-Usual (TAU; n=14)
Time Frame: 20 month treatment
Assessments: Pre-treatmentPost-treatment
Conditions: Dialectical Behavior Therapy (DBT; n=21)
Treatment-as-Usual (TAU; n=14)
Time Frame: 20 month treatment
Assessments: Pre-treatmentPost-treatment
842002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subjects: (35 male, 11 female)Subjects: (35 male, 11 female)Subjects: (35 male, 11 female)Subjects: (35 male, 11 female)
Patients on intermediate and medium Patients on intermediate and medium security forensic wards security forensic wards
Age range 37.6 yearsAge range 37.6 years
BPD = 50%; ASPD= 33%; 45% either BPD = 50%; ASPD= 33%; 45% either schizophrenic or bi-polarschizophrenic or bi-polar
Patients on intermediate and medium Patients on intermediate and medium security forensic wards security forensic wards
Age range 37.6 yearsAge range 37.6 years
BPD = 50%; ASPD= 33%; 45% either BPD = 50%; ASPD= 33%; 45% either schizophrenic or bi-polarschizophrenic or bi-polar
852002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT: Pre < postDBT: Pre < postDBT: Pre < postDBT: Pre < post
Depressed and hostile moodDepressed and hostile mood Paranoia, Paranoia, Psychotic behaviors, Psychotic behaviors, Maladaptive interpersonal coping stylesMaladaptive interpersonal coping styles Staff burn-out (trend)Staff burn-out (trend)
TAU: Pre = postTAU: Pre = post
Depressed and hostile moodDepressed and hostile mood Paranoia, Paranoia, Psychotic behaviors, Psychotic behaviors, Maladaptive interpersonal coping stylesMaladaptive interpersonal coping styles Staff burn-out (trend)Staff burn-out (trend)
TAU: Pre = postTAU: Pre = post
McCann & Ball
86
Evaluation of DBT-Inpatient Evaluation of DBT-Inpatient TreatmentTreatment
Evaluation of DBT-Inpatient Evaluation of DBT-Inpatient TreatmentTreatment
University of Freiburg, GermanyUniversity of Freiburg, Germany
Bohus, Bohus, Haaf, Stiglmayr, Pohl, Bohme, & Linehan 2001
University of Freiburg, GermanyUniversity of Freiburg, Germany
Bohus, Bohus, Haaf, Stiglmayr, Pohl, Bohme, & Linehan 2001
872002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. TAU-Waiting List DBT vs. TAU-Waiting List a Controlled Studya Controlled Study
Inclusion: BPD: SCID II; DIB-R>7Inclusion: BPD: SCID II; DIB-R>7 Exclusion: lifetime schizophrenia, Exclusion: lifetime schizophrenia,
bipolar I, current substance abusebipolar I, current substance abuse Measure points: Measure points:
pre: admission pre: admission
post: 1 month after dischargepost: 1 month after discharge
Inclusion: BPD: SCID II; DIB-R>7Inclusion: BPD: SCID II; DIB-R>7 Exclusion: lifetime schizophrenia, Exclusion: lifetime schizophrenia,
bipolar I, current substance abusebipolar I, current substance abuse Measure points: Measure points:
pre: admission pre: admission
post: 1 month after dischargepost: 1 month after discharge
882002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. TAU - Waiting ListDBT vs. TAU - Waiting List
DBTDBT n=31n=31 age=29.1age=29.1 mean DSM-IV 6.81 mean DSM-IV 6.81 Comorbidities:Comorbidities:
• Anxiety disorder 77%Anxiety disorder 77%• Eating disorder 50%Eating disorder 50%• Depressive Depressive
Disorder 80%Disorder 80%
DBTDBT n=31n=31 age=29.1age=29.1 mean DSM-IV 6.81 mean DSM-IV 6.81 Comorbidities:Comorbidities:
• Anxiety disorder 77%Anxiety disorder 77%• Eating disorder 50%Eating disorder 50%• Depressive Depressive
Disorder 80%Disorder 80%
TAU - Waiting ListTAU - Waiting List n=19n=19 age=29.5age=29.5 mean DSM-IV 7.63mean DSM-IV 7.63 Comorbidities:Comorbidities:
• Anxiety disorder 76%Anxiety disorder 76%• Eating disorder 41%Eating disorder 41%• Depressive Depressive
Disorder 82%Disorder 82%
TAU - Waiting ListTAU - Waiting List n=19n=19 age=29.5age=29.5 mean DSM-IV 7.63mean DSM-IV 7.63 Comorbidities:Comorbidities:
• Anxiety disorder 76%Anxiety disorder 76%• Eating disorder 41%Eating disorder 41%• Depressive Depressive
Disorder 82%Disorder 82%
892002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Pre-post comparison and group vs. Pre-post comparison and group vs. time differences: Depressiontime differences: Depression
BDI HAMD
0
5
10
15
20
25
TAU-Waiting List Treatment
**
normal range
**
0
5
10
15
20
25
30
35
40
TAU-Waiting List DBT
**
**
normal range
TAU DBT
902002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Pre-post comparison and group vs. Pre-post comparison and group vs. time differences: Anxietytime differences: Anxiety
STAI HAMA
0
5
10
15
20
25
30
TAU-Waiting List Treatment
**
normal range
**
40
45
50
55
60
65
70
75
80
TAU-Waiting List Treatment
**
**
normal range
TAU DBT
912002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Pre-post comparison and group vs. Pre-post comparison and group vs. time differences: SCL-90-Rtime differences: SCL-90-R
GSI PSDI
1,0
1,2
1,4
1,6
1,8
2,0
2,2
2,4
2,6
2,8
3,0
TAU-Waiting List
**
Treatment
**
normal range
0,0
0,5
1,0
1,5
2,0
2,5
TAU-Waiting List Treatment
**
**
normal range
TAU DBT
922002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Pre-post comparison and group vs. time Pre-post comparison and group vs. time differences: Dissociationdifferences: Dissociation
DES
0
5
10
15
20
25
30
35
40
TAU-Waiting List Treatment
**
normal range
*TAU DBT
932002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Pre-post comparison and group vs. Pre-post comparison and group vs. time differences: Angertime differences: Anger
STAXI
1
2
3
4
5
6
7
8
9
TAU-Waiting List Treatment
normal range
TAU DBT
942002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Pre-post comparison and group vs. time Pre-post comparison and group vs. time differences: Social Integrationdifferences: Social Integration
GAF
0
10
20
30
40
50
60
70
80
90
100
TAU-Waiting List Treatment
normal range
**
**TAU DBT
952002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Effect Sizes TAU-DBTEffect Sizes TAU-DBT
0,0
0,5
1,0
1,5
GAF SCL-90-R(GSI)
SCL-90-R(PSDI)
DES BDI HAMD STAI HAMA STAXI
TAU-Waiting-List n=19
Treatment n=31
small
medium
large
962002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Responder criteriaResponder criteria
Every patient who had values above Every patient who had values above the the median in at least 5 of 9 pre-post-median in at least 5 of 9 pre-post-differencesdifferences (dissociation, GAF, (dissociation, GAF, HAMA, STAI, BDI, HAMD, STAXI, HAMA, STAI, BDI, HAMD, STAXI, SCL-GSI, SCL-Intensity) was SCL-GSI, SCL-Intensity) was allocated to the responder-groupallocated to the responder-group
972002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Responder criteriaResponder criteria
Discriminant Analysis: All of the 9 Discriminant Analysis: All of the 9 variables accounted significantly for variables accounted significantly for the classification into responder- and the classification into responder- and non-responder-groups and are non-responder-groups and are responsible for 71.8% of the variance responsible for 71.8% of the variance between the groups (Fbetween the groups (F8,208,20=6.35, =6.35, p=.000***).p=.000***).
982002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
GAFGAF
0
10
20
30
40
50
60
70
80
90
100
TAU-Waiting List Treatment non-respondersresponders
normal range
** ** *
TAU DBT Responders Non-Responders
992002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Therapy Response: Effect sizesTherapy Response: Effect sizes
0,0
0,5
1,0
1,5
2,0
2,5
3,0
GAF SCL-90-R(GSI)
SCL-90-R(PSDI)
DES BDI HAMD STAI HAMA STAXI
TAU-Waiting-List n=19Treatment n=31Responder n= 16Non-Responder n=15
1002002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Predictor VariablesPredictor Variables(Discriminant Analysis)(Discriminant Analysis)
Clinical variables: Clinical variables: Frequency of comorbid axis I disordersFrequency of comorbid axis I disorders Frequency and days of lifetime Frequency and days of lifetime
hospitalizations hospitalizations Frequency of lifetime suicide attemptsFrequency of lifetime suicide attempts
Current or lifetime diagnosis of Current or lifetime diagnosis of • comorbid anxiety disorder comorbid anxiety disorder • eating disordereating disorder• depressiondepression
Clinical variables: Clinical variables: Frequency of comorbid axis I disordersFrequency of comorbid axis I disorders Frequency and days of lifetime Frequency and days of lifetime
hospitalizations hospitalizations Frequency of lifetime suicide attemptsFrequency of lifetime suicide attempts
Current or lifetime diagnosis of Current or lifetime diagnosis of • comorbid anxiety disorder comorbid anxiety disorder • eating disordereating disorder• depressiondepression
1012002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Predictor VariablesPredictor Variables(Discriminant Analysis)(Discriminant Analysis)
Diagnostic variables: Diagnostic variables: value of the DIB-R criterias value of the DIB-R criterias number of met DSM-IV criteriasnumber of met DSM-IV criterias severity of pre-assessment symptomsseverity of pre-assessment symptoms
Diagnostic variables: Diagnostic variables: value of the DIB-R criterias value of the DIB-R criterias number of met DSM-IV criteriasnumber of met DSM-IV criterias severity of pre-assessment symptomsseverity of pre-assessment symptoms
1022002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Predictor Variables Predictor Variables (Discriminant Analysis)(Discriminant Analysis)
Social variables:Social variables: employment employment psychological or psychosocial stress at beginning of psychological or psychosocial stress at beginning of
therapy therapy age age quality of family relationshipsquality of family relationships quality of leisure activitiesquality of leisure activities global contentment with social aspects of one’s lifeglobal contentment with social aspects of one’s life
Social variables:Social variables: employment employment psychological or psychosocial stress at beginning of psychological or psychosocial stress at beginning of
therapy therapy age age quality of family relationshipsquality of family relationships quality of leisure activitiesquality of leisure activities global contentment with social aspects of one’s lifeglobal contentment with social aspects of one’s life
1032002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT Skills Training vs. No SkillsDBT Skills Training vs. No SkillsOne Year: Out-patient (Linehan et al.)One Year: Out-patient (Linehan et al.)
DBT Skills Training vs. No SkillsDBT Skills Training vs. No SkillsOne Year: Out-patient (Linehan et al.)One Year: Out-patient (Linehan et al.)
DBT skills training + individual non-DBT skills training + individual non-DBT psychotherapy (DBT Skills) DBT psychotherapy (DBT Skills) vs.vs.
Individual non-DBT psychotherapy Individual non-DBT psychotherapy only (NO DBT Skills)only (NO DBT Skills)
• DBT Skills = No DBT Skills: all DBT Skills = No DBT Skills: all measuresmeasures
DBT skills training + individual non-DBT skills training + individual non-DBT psychotherapy (DBT Skills) DBT psychotherapy (DBT Skills) vs.vs.
Individual non-DBT psychotherapy Individual non-DBT psychotherapy only (NO DBT Skills)only (NO DBT Skills)
• DBT Skills = No DBT Skills: all DBT Skills = No DBT Skills: all measuresmeasures
1042002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
DBT vs. Treatment-as-UsualDBT vs. Treatment-as-Usualfor Incarcerated Juvenile for Incarcerated Juvenile
Offenders Offenders Echo Glen Children’s Center Echo Glen Children’s Center
Trupin, Stewart, Boesky, McClung, BeachTrupin, Stewart, Boesky, McClung, Beach
DBT vs. Treatment-as-UsualDBT vs. Treatment-as-Usualfor Incarcerated Juvenile for Incarcerated Juvenile
Offenders Offenders Echo Glen Children’s Center Echo Glen Children’s Center
Trupin, Stewart, Boesky, McClung, BeachTrupin, Stewart, Boesky, McClung, Beach
1052002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Design: Parallel Control GroupDesign: Parallel Control GroupDesign: Parallel Control GroupDesign: Parallel Control Group
ConditionsConditions:: DBT: Staff trained > 80 hrs. DBT: Staff trained > 80 hrs. (n=22)(n=22)
DBT: Staff trained 16 hrs. DBT: Staff trained 16 hrs. (n=15)(n=15)
Time FrameTime Frame:: 10 months10 months
AssessmentsAssessments:: Pre-treatmentPre-treatment
Post-treatment Post-treatment
ConditionsConditions:: DBT: Staff trained > 80 hrs. DBT: Staff trained > 80 hrs. (n=22)(n=22)
DBT: Staff trained 16 hrs. DBT: Staff trained 16 hrs. (n=15)(n=15)
Time FrameTime Frame:: 10 months10 months
AssessmentsAssessments:: Pre-treatmentPre-treatment
Post-treatment Post-treatment
1062002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Subject Demographic CharacteristicsSubject Demographic CharacteristicsSubject Demographic CharacteristicsSubject Demographic Characteristics Female, adolescent offenders Female, adolescent offenders
incarcerated on general and mental incarcerated on general and mental health cottages health cottages
Age: M=15 yrs.Age: M=15 yrs. % Axis I disorders: 76%% Axis I disorders: 76% Number prior offenses: M=5.5Number prior offenses: M=5.5
Female, adolescent offenders Female, adolescent offenders incarcerated on general and mental incarcerated on general and mental health cottages health cottages
Age: M=15 yrs.Age: M=15 yrs. % Axis I disorders: 76%% Axis I disorders: 76% Number prior offenses: M=5.5Number prior offenses: M=5.5
1072002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG2002 The Behavioral Technology Transfer Group (BTTG) Slides Provided Courtesy of BTTG
Significant ChangesSignificant Changes
DBT 80 hrs. trainingDBT 80 hrs. training• Reduced severe behavior problems Reduced severe behavior problems
(parasuicide, aggression, class (parasuicide, aggression, class disruptions)disruptions)
• Reduced staff use of punitive actions Reduced staff use of punitive actions (compared to previous year) (compared to previous year)
DBT 16 hrs. trainingDBT 16 hrs. training• No reduction in behavior problemsNo reduction in behavior problems• Increased staff use of punitive actionsIncreased staff use of punitive actions
DBT 80 hrs. trainingDBT 80 hrs. training• Reduced severe behavior problems Reduced severe behavior problems
(parasuicide, aggression, class (parasuicide, aggression, class disruptions)disruptions)
• Reduced staff use of punitive actions Reduced staff use of punitive actions (compared to previous year) (compared to previous year)
DBT 16 hrs. trainingDBT 16 hrs. training• No reduction in behavior problemsNo reduction in behavior problems• Increased staff use of punitive actionsIncreased staff use of punitive actions