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Dialectical behavior therapy-skills system for cognitively challenged individuals with self-harm: a Swedish pilot study.

ABSTRACT: Background: Dialectical behavior therapy (DBT) is an evidence-based treatment for self-harm and emotion regulation difficulties. A modified version, DBT-Skills System (DBT-SS), has been developed in the USA for individuals with cognitive difficulties. The present study is a pilot study, testing the DBT-SS in a Swedish context. Methods: Six participants were treated with individual therapy and group skills training for 48 sessions each. A case series design was used to follow individual development over time. The primary outcome measure was reduction in challenging behaviors. Secondary outcomes were level of functioning in daily life, hospital admissions, and resilience and vulnerabilities in different risk domains. Data was analyzed using time-series diagrams. Effect sizes of changes were calculated using Cohen's d. Results: Challenging behaviors decreased over time and participants' global level of functioning increased. There was a reduction in number of hospital admissions over time. As for resilience and vulnerabilities, participants' overall level of risk in various areas remained unchanged or decreased after treatment. Conclusions: The results indicate that DBT-SS might be a promising treatment for cognitively challenged individuals with emotion regulation difficulties and challenging behaviors in a Swedish context. The study provides suggestions for a future randomized controlled trial. Supplemental data for this article is available online at here.

SUBMITTER: Rosendahl-Santillo A

PROVIDER: S-EPMC10281435 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Dialectical behavior therapy-skills system for cognitively challenged individuals with self-harm: a Swedish pilot study.

Rosendahl-Santillo Alexandra A Lantto Reid R Nylander Lena L Thylander Christina C Schultz Pernilla P Brown Julie J Wallinius Märta M Westling Sofie S

International journal of developmental disabilities 20210901 4

<b>Background:</b> Dialectical behavior therapy (DBT) is an evidence-based treatment for self-harm and emotion regulation difficulties. A modified version, DBT-Skills System (DBT-SS), has been developed in the USA for individuals with cognitive difficulties. The present study is a pilot study, testing the DBT-SS in a Swedish context. <b>Methods:</b> Six participants were treated with individual therapy and group skills training for 48 sessions each. A case series design was used to follow indivi ...[more]

PMID: 37346252

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Project description:ImportancePeople at risk of self-harm or suicidal behavior can be accurately identified, but effective prevention will require effective scalable interventions.ObjectiveTo compare 2 low-intensity outreach programs with usual care for prevention of suicidal behavior among outpatients who report recent frequent suicidal thoughts.Design, setting, and participantsPragmatic randomized clinical trial including outpatients reporting frequent suicidal thoughts identified using routine Patient Health Questionnaire depression screening at 4 US integrated health systems. A total of 18 882 patients were randomized between March 2015 and September 2018, and ascertainment of outcomes continued through March 2020.InterventionsPatients were randomized to a care management intervention (n = 6230) that included systematic outreach and care, a skills training intervention (n = 6227) that introduced 4 dialectical behavior therapy skills (mindfulness, mindfulness of current emotion, opposite action, and paced breathing), or usual care (n = 6187). Interventions, lasting up to 12 months, were delivered primarily through electronic health record online messaging and were intended to supplement ongoing mental health care.Main outcomes and measuresThe primary outcome was time to first nonfatal or fatal self-harm. Nonfatal self-harm was ascertained from health system records, and fatal self-harm was ascertained from state mortality data. Secondary outcomes included more severe self-harm (leading to death or hospitalization) and a broader definition of self-harm (selected injuries and poisonings not originally coded as self-harm).ResultsA total of 18 644 patients (9009 [48%] aged 45 years or older; 12 543 [67%] female; 9222 [50%] from mental health specialty clinics and the remainder from primary care) contributed at least 1 day of follow-up data and were included in analyses. Thirty-one percent of participants offered care management and 39% offered skills training actively engaged in intervention programs. A total of 540 participants had a self-harm event (including 45 deaths attributed to self-harm and 495 nonfatal self-harm events) over 18 months following randomization: 172 (3.27%) in care management, 206 (3.92%) in skills training, and 162 (3.27%) in usual care. Risk of fatal or nonfatal self-harm over 18 months did not differ significantly between the care management and usual care groups (hazard ratio [HR], 1.07; 97.5% CI, 0.84-1.37) but was significantly higher in the skills training group than in usual care (HR, 1.29; 97.5% CI, 1.02-1.64). For severe self-harm, care management vs usual care had an HR of 1.03 (97.5% CI, 0.71-1.51); skills training vs usual care had an HR of 1.34 (97.5% CI, 0.94-1.91). For the broader self-harm definition, care management vs usual care had an HR of 1.10 (97.5% CI, 0.92-1.33); skills training vs usual care had an HR of 1.17 (97.5% CI, 0.97-1.41).Conclusions and relevanceAmong adult outpatients with frequent suicidal ideation, offering care management did not significantly reduce risk of self-harm, and offering brief dialectical behavior therapy skills training significantly increased risk of self-harm, compared with usual care. These findings do not support implementation of the programs tested in this study.Trial registrationClinicalTrials.gov Identifier: NCT02326883.

Project description:IntroductionThe Five Self-Harm Behavior Groupings Measure (5S-HM) is a novel assessment that evaluates behaviours which may go undetected by existing measures. Self-harm is formulated across directness and lethality spectra, including under-studied behaviors such as indirect self-harm, harmful self-neglect and sexual self-harm. Aims of the study were to: (1) empirically evaluate the 5S-HM; (2) to determine whether the 5S-HM generates relevant new information with respect to the forms and functions given by participants for self-harm within a clinical sample; (3) to test the utility and novel contributions of the Unified Model of Self-Harm and the 5S-HM by extension.MethodsData were collected from N = 199 individuals (Mage = 29.98, SD = 8.41, 86.4% female), receiving specialized evidence-based treatments for self-harm, borderline personality disorder or eating disorders. Construct validity was determined via Spearman correlations, and internal consistency was established from Cronbach's alpha. Inductive thematic analysis was used to analyze and interpret qualitative data on reasons, forms and functions participants reported in relation to self-harm following Braun and Clarke's analytic guidelines. Thematic mapping was used to summarize qualitative data.ResultsTest-retest reliability on a subsample of n = 24, tested 14 days after Time 1 was supported by a good intraclass correlation (0.68). Internal consistency (Cronbach's alpha = 0.75) was acceptable to good, as was construct validity comparing the 5S-HM total score to two validated self-harm measures (rho = 0.40, p < 0.01; rho = 0.26, p < 0.01). A thematic map depicting antecedents and consequences of self-harm over time suggests that self-harm is initiated by negative emotional states and self-intolerance. Novel findings in relation to sexual self-harm indicated that reasons for these behaviors were either to improve or worsen one's situation through being hurt by someone else.DiscussionThe empirical analyses of the 5S-HM demonstrate that it is a robust measure for use in clinical and research settings. Thematic analyses proposed explanations for why self-harm behaviors are initiated and how they are reinforced over time. Sexual self-harm in particular requires further careful study.

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Dialectical behavior therapy-skills system for cognitively challenged individuals with self-harm: a Swedish pilot study.

Publications

Dialectical behavior therapy-skills system for cognitively challenged individuals with self-harm: a Swedish pilot study.

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