Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients
01 Dec 1991-Archives of General Psychiatry (American Medical Association)-Vol. 48, Iss: 12, pp 1060-1064
TL;DR: Subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days.
Abstract: A randomized clinical trial was conducted to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder. The treatment lasted 1 year, with assessment every 4 months. The control condition was "treatment as usual" in the community. At most assessment points and during the entire year, the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. There were no between-group differences on measures of depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures decreased throughout the year.
Citations
More filters
TL;DR: In this paper, a two-component model of mindfulness is proposed and each component is specified in terms of specific behaviors, experiential manifestations, and implicated psychological processes, and discussed implications for instrument development and briefly describing their own approach to measurement.
Abstract: There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
5,534 citations
TL;DR: In this paper, a review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions, and suggests that these interventions may be helpful in the treatment of several disorders.
Abstract: Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.
4,204 citations
TL;DR: In this article, the authors evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence.
Abstract: This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.
2,942 citations
TL;DR: The role of mindfulness in curtailing negative functioning and enhancing positive outcomes in several important life domains, including mental health, physical health, behavioral regulation, and interpersonal relationships is discussed in this paper.
Abstract: Interest in mindfulness and its enhancement has burgeoned in recent years. In this article, we discuss in detail the nature of mindfulness and its relation to other, established theories of attention and awareness in day-to-day life. We then examine theory and evidence for the role of mindfulness in curtailing negative functioning and enhancing positive outcomes in several important life domains, including mental health, physical health, behavioral regulation, and interpersonal relationships. The processes through which mindfulness is theorized to have its beneficial effects are then discussed, along with proposed directions for theoretical development and empirical research.
2,796 citations
Cites background from "Cognitive-Behavioral Treatment of C..."
...…in self-mutilating behaviors, drug abuse, and parasuicidal attempts (e.g., Bohus, Haaf, Stiglmayr, Pohl, Bohme, & Linehan, 2000; Koons et al., 2001; Linehan et al., 1991; Linehan et al., 2002; Linehan et al., 1999; Turner, 2000; Verheul, Bosch, Koeter, De Ridder, Stijnen, & Brink et al., 2003)....
[...]
...DBT has been shown to produce robust improvements in behavioral self-control in female borderline personality disorder populations, manifest in reductions in self-mutilating behaviors, drug abuse, and parasuicidal attempts (e.g., Bohus, Haaf, Stiglmayr, Pohl, Bohme, & Linehan, 2000; Koons et al., 2001; Linehan et al., 1991; Linehan et al., 2002; Linehan et al., 1999; Turner, 2000; Verheul, Bosch, Koeter, De Ridder, Stijnen, & Brink et al., 2003)....
[...]
TL;DR: It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.
Abstract: A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.
2,728 citations
References
More filters
TL;DR: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Abstract: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations." Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15These have been well summarized in a review article by Lorr11on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
35,176 citations
TL;DR: A scale designed to quantify hopelessness was administered to several diverse samples of patients to assess its psychometric properties and was found to have a high degree of internal consistency and showed a relatively high correlation with the clinical ratings of hopelessness and other self-administered measures of despair.
Abstract: A scale designed to quantify hopelessness was administered to several diverse samples of patients to assess its psychometric properties. This scale was found to have a high degree of internal consistency and showed a relatively high correlation with the clinical ratings of hopelessness and other self-administered measures of hopelessness. Furthermore, the scale was sensitive to changes in the patient's state of depression over time. An affective, a motivational, and a cognitive factor were extracted.
4,754 citations
TL;DR: The development of an instrument to measure a range of beliefs potentially important as reasons for not committing suicide and the results indicated that the RFL differentiated suicidal from nonsuicidal individuals in both samples are described.
Abstract: University of Washington Catholic University of AmericaStevan Lars Nielsen and John A. ChilesUniversity of WashingtonThe studies presented here describe the development of an instrument to measurea range of beliefs potentially important as reasons for not committing suicide.Sixty-five individuals generated 72 distinct reasons; these were reduced to 48 byfactor analyses performed on two additional samples, and the items were arrangedinto the Reasons for Living Inventory (RFL), which requires a rating of howimportant each reason would be for living if suicide was contemplated. In ad-dition, factor analyses indicated six primary reasons for living: Survival and Cop-ing Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide,Fear of Social Disapproval, and Moral Objections. The RFL was then given totwo additional samples, 197 Seattle shoppers and 175 psychiatric inpatients. Bothsamples were divided into several suicidal (ideators and parasuicides) and non-suicidal groups. Separate multivariate analyses of variance indicated that the RFLdifferentiated suicidal from nonsuicidal individuals in both samples. In the shop-ping-center sample, the Fear of Suicide scale further differentiated between pre-vious ideators and previous parasuicides. In the clinical sample, the Child-RelatedConcerns scales differentiated between current suicide ideators and current para-suicides. In both samples, the Survival and Coping, the Responsibility to Family,and the Child-Related Concerns scales were most useful in differentiating thegroups. Results were maintained when the effect of recent stress was held constant.The frequency of suicidal behavior sug- point in their lifetime; between 53% and 67%gests that it is a phenomenon that cannot be report seriously considering it.ignored. Over 25,000 individuals a year kill The majority of research in the field ofthemselves in the United States (U.S. Vital suicidology, to date, has been directed atStatistics, 1973, 1975), and it is estimated identifying characteristics of suicidal personsthat two to eight times this number, or from to enhance prediction of suicidal behavior50,000 to 200,000 persons a year parasuicide (Beck, Resnick, & Lettieri, 1974; Kreitman,(i.e., intentionally self-injure, behavior usu- 1977;Neuringer, 1974). With few exceptionsally labeled in the U.S. as attempted suicide; (e.g., Goodstein, 1982) almost all of this workBerman, 1975). Linehan and colleagues (Li- has focused on identifying maladaptive at-nehan & Laffaw, in press; Linehan & Nielsen, tributes of suicidal persons. Little attention1981; Linehan, Note 1) found that from 10% has been given the question of whether sui-to 16% of an adult, general population in cidal persons lack important adaptive char-Seattle report attempting suicide at some acteristics present among nonsuicidal indi-viduals, and, if so, what these characteristicsThis research was supported by National Institute might be.Grant MH34486. Focusing on adaptive, life-maintaining
901 citations
TL;DR: The content, administration, reliability, construct validity, and training requirements for a semistructured diagnostic interview for borderline patients show that the interview provides a reasonably constructed and reliable method for researchers and clinicians interested in identifying the syndrome of borderline personality disorders.
Abstract: The authors describe the content, administration, reliability, construct validity, and training requirements for a semistructured diagnostic interview for borderline patients. The interview is composed of operationally defined and scored variables that assess five areas of functioning considered most characteristic of borderline patients--social adaptation, impulse/action patterns, affects, psychosis, and interpersonal relations. Their results show that the interview provides a reasonably constructed and reliable method for researchers and clinicians interested in identifying the syndrome of borderline personality disorders. Although existing research supports the clinical utility of defining borderline patients with the diagnostic interview for borderline patients, both the diagnosis and the content of the interview may require revisions.
471 citations
TL;DR: To test the validity of the DSM-III diagnosis of borderline personality disorder (BPD), the phenomenology, family history, treatment response, and four-to-seven-year long-term outcome of a cohort of 33 patients meeting DSM- III criteria for BPD are examined.
Abstract: • To test the validity of theDSM-IIIdiagnosis of borderline personality disorder (BPD), we examined the phenomenology, family history, treatment response, and four-to-seven-year long-term outcome of a cohort of 33 patients meetingDSM-IIIcriteria for BPD. We found that (1) BPD could be distinguished readily fromDSM-IIIschizophrenia; (2) BPD did not appear to represent "borderline affective disorder," although many patients displayed BPD and major affective disorder concomitantly; and (3) BPD could not be distinguished on any of the Indices from histrionic and antisocial personality disorders.
388 citations