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Dialectical behaviour therapy in an Irish community mental health setting

Published online by Cambridge University Press:  13 June 2014

Richard Blennerhassett ,
Lindsay Bamford ,
Anthony Whelan ,
Sarah Jamieson  and
Jennifer Wilson O'Raghaillaigh
Richard Blennerhassett*
Affiliation:
St. Ita's Hospital, Portrane, Co. Dublin, Ireland
Lindsay Bamford
Affiliation:
Artane, Mental Health Centre, Kilmore Rd, Artane, Dublin 5, Ireland
Anthony Whelan
Affiliation:
Artane, Mental Health Centre, Kilmore Rd, Artane, Dublin 5, Ireland
Sarah Jamieson
Affiliation:
St. James Hospital, Dublin 8, Ireland
Jennifer Wilson O'Raghaillaigh
Affiliation:
Beaumont Hospital, Dublin 9, Ireland
*
*Correspondence E-mail: [email protected]
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Abstract

Objectives:

Dialectical behaviour therapy (DBT) is a recommended treatment of patients with borderline personality disorder, yet there are few descriptions of the approach in public community mental health settings where the majority of such patients present. This study describes the development and evaluation of a DBT programme in an Irish setting.

Methods:

The DBT programme was run over a six month period. Participants were assessed at baseline and post intervention with the following instruments: The Structured Clinical Interview for DSM III R personality disorders (SCID II), the clinical Outcomes in Routine Evaluation (CORE) and the symptom checklist 90 Revised (SCL-90-Revised). Inpatient bed usage was determined from case note review.

Results:

Outcome data was available for eight subjects. Significant improvement (p < 0.005) was seen on all CORE subscales. SCL-90-R showed significant improvement (p < 0.05) on the global severity index and on the positive symptom distress index. A decrease in self harming behaviour was found. Subjects' inpatient bed days dropped from a mean of 58 in the year pre intervention to a mean of four days in the year post intervention. A novel finding was that 43% of subjects who originally fulfilled criteria for avoidant personality disorder no longer did so post intervention.

Conclusions:

The study found that DBT can be applied in a community mental health setting with benefits similar to more specialist settings. Significant difficulties were encountered in implementing the programme. The clinical implications are that specialist psychotherapy services need to be an integral part of psychiatric services to achieve better outcomes for patients with borderline personality disorder.

Keywords

Dialectical behaviour therapy (DBT)Community mental health settingBoderline personality disorder
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 26 , Issue 2 , June 2009 , pp. 59 - 63
Copyright
Copyright © Cambridge University Press 2009

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References

1.Linehan, MM. Dialectical Behavior Therapy: A Cognitive-Behavioral Approach to Parasuicide. J Personality Disorder 1987;1: 328–333.CrossRefGoogle Scholar
2.Linehan, MM, Armstrong, HE, Suarez, A, Allmon, D, Heard, HL. Cognitive Behavioural Treatment of Chronically Parasinoidal Borderline Patients. Arch Gen Psychiatry 1991; 48: 1060–1064.CrossRefGoogle Scholar
3.Linehan, MM. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press, 1993.Google Scholar
4.Linehan, MM. Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press, 1993.Google Scholar
5.Koons, CR, Robins, CJ, Tweed, JLet al.Efficacy of Dialectical Behavior therapy in Women Veterans with Borderline Personality Disorder. Behavior Therapy 2001; 32:371–390.CrossRefGoogle Scholar
6.Verheul, R, Van Den Bosch, LMC, Koeter, MWJ, De Ridder, MAJ, Stijnen, T, Van Den Brink, W. Dialectical Behaviour Therapy for Women with Borderline Personality Disorder. Br J Psychiatry 2003; 182: 135–140.CrossRefGoogle ScholarPubMed
7.Gunderson, JG. Borderline Personality Disorder: A Clinical Guide. Washington, DC: American Psychiatric Publishing 2001.Google Scholar
8.Linehan, MK, Comtois, KA, Murray, AMet al.Two Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviours and Borderline Personality Disorder, Arch Gen Psychiatry 2006; 63: 757–766.CrossRefGoogle ScholarPubMed
9.Blennerhassett, R, Wilson O'Raghallaigh, J. Dialectical Behaviour Therapy in the treatment of Borderline Personality Disorder. Br J Psychiatry 2005; 186: 278–280.CrossRefGoogle ScholarPubMed
10.The Mental Health Center of Greater Manchester, New Hampshire. Integrating Dialectical Behavioral Therapy into a Community Mental Health Program. Psychiatric Services 1998; 49: 1338–1340.CrossRefGoogle Scholar
11.Turner, RM. Naturalistic Evaluation of Dialectical Behavior Therapy – Oriented Treatment for Borderline Personality Disorder. Cognitive and Behavioral Practice 2000; 7:413–419.CrossRefGoogle Scholar
12.McQuillan, A, Nicastro, R, Guenot, F, Girard, M, Lissner, C, Ferrero, F. Intensive Dialectical Behavior therapy for outpatients with borderline personality Disorder who are in crisis. Psychiatric Serv 2005; 56(2): 193–197.CrossRefGoogle ScholarPubMed
13.Zinkler, M, Gaglia, A, Ragagopal Arokiadass, SM, Farhy, E. Dialectical Behaviour Therapy: Implementation and Outcomes. Psychiatric Bull 2007; 231: 249–252.CrossRefGoogle Scholar
14.Kass, F, Skodol, A, Charles, E, Spitzer, RL, Williams, JBW. Scaled ratings of DSM III Personality Disorders. Am J Psychiatry 1985; 142: 627–630.Google ScholarPubMed
15.American Psychiatric Association Practice Guidelines for the Treatment of Patients with Borderline Personality Disorder. Am J Psychiatry 2001; 158(Suppl): 1–52.Google Scholar
16.A Vision for Change. Government Publications Office, Dublin, 2006.Google Scholar
17.The Report of the Inspector of Mental Hospitals. Government Publications Office, Dublin, 2001.Google Scholar
18.Rashleigh, C. An evaluation of a Dialectical Behaviour Therapy Social Skills Group in a Community Mental Health Service for Adults who Deliberately Self Harm. Unpublished thesis, MSc in Counselling Psychology, Trinity College Dublin, 2003.Google Scholar
19.Spitzer, RL, Williams, JBW. Structured Clinical Interview for DSM III R Personality Disorders (SCID II). New York, New York State Psychiatric Institute, Biometrics Research, 1985.Google Scholar
20.Evans, E. Mellor-Clark, J, Margison, F, Barkham, M, Audin, K, and Connell, J. CORE: Clinical Outcomes in Routine Evaluation. J Mental Health 2000; 9(3): 247–255.CrossRefGoogle Scholar
21.Derogatis, LR. SCL-90: Administration, Scoring and Procedure Manual for the R (Revised Version). Baltimore: John Hopkins University School of Medicine, 1977.Google Scholar
22.Tyrer, P. Deconstructing Personality Disorder. Quart J Mental Health 2006; 1(1): 20–24.Google Scholar
23.Hawkins, KA, Sinha, R. Can line clinicians master the conceptual complexities of dialectical behavior therapy? An Evaluation of a State Department of Mental Health Training Program. J Psychiatric Res 1998; 32: 379–384.CrossRefGoogle ScholarPubMed
24.Lynch, TR, Chapman, AL, Zachary, Rossenthall M, Kuo, JR, Linehan, MM. Mechanisms of Change in Dialectical Behavior Therapy: Theoretical and Empirical Observations. J Clin Psychol 2006; 62(4): 459–480.CrossRefGoogle ScholarPubMed
25.Linehan, MM, Dimeff, LA, Reynolds, SKet al.Dialectical Behavior Therapy versus Comprehensive Validation Therapy plus 12-step for the treatment of opioid dependent women meeting criteria for Borderline Personality Disorder. Drug and Alcohol Dependence 2002; 67: 13–26.CrossRefGoogle ScholarPubMed
26.Fonagy, P, Bateman, A. Progress in the treatment of Borderline Personality Disorder. Br J Psychiatry 2006; 188: 1–3.CrossRefGoogle ScholarPubMed
27.Gabbard, GO. Do all Roads lead to Rome? New Findings on Borderline Personality Disorder. Am J Psychiatry 2007 164; 6: 853–855.CrossRefGoogle Scholar
28.Clarkin, JF, Levy, KN, Lenzenweger, MF, Kernberg, OF. Evaluating three treatments for Borderline Personality Disorder: A multiwave study. Am J Psychiatry 2007; 164: 922–928CrossRefGoogle ScholarPubMed
29.Blennerhassett, R. Dialectical Behaviour Therapy in Clinical Practice. Quart J Mental Health 2008, 1(3): 15–21.Google Scholar
30.Carr, A. The effectiveness of Psychotherapy. The Irish Council for Psychotherapy. 2007.Google Scholar