Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder
Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder
复制标题
DOI：
10.1016/s0376-8716(02)00011-x
复制
发表时间：
2002-06-01
影响因子：
4.2
通讯作者：
Kivlahan, DR
中科院分区：
文献类型：
--
作者：
Linehan, MM;Dimeff, LA;Kivlahan, DR
我们进行了一项随机对照试验来评估辩证行为疗法（DBT）是否有效。一种综合行为改变和激进接受策略的治疗方法，对患有边缘型人格障碍的海洛因依赖妇女（N = 23）比12步综合验证疗法（CVT + 12S）更有效，后者是一种手动方法，提供了DBT中使用的基于接受的主要策略，并结合了参与12步计划。除心理治疗外，受试者还同时接受阿片激动剂治疗和足剂量的LAAM（每周三次：模态剂量90/90/130 mg）。治疗持续12个月。通过每周三次尿检和自我报告来测量药物使用结果。主要发现有三个。第一。尿液分析结果表明，两种治疗条件都有效地减少了阿片类药物的使用。随机化后16个月（治疗后4个月）。所有参与者尿检中阿片类药物阳性的比例都很低（DBT组为27%，CVT + 12S组为33%）。关于条件间差异，DBT组的参与者在12个月的积极治疗中保持了平均阿片类药物使用量的减少，而CVT+12S组的参与者在最后4个月的治疗中显著增加了阿片类药物使用量。第二。CVT + 12S在治疗的一年中保留了所有12名参与者，而DBT的保留率为64%。第三。在治疗后和16个月的随访评估中，两种治疗条件下的受试者的精神病理水平相对于基线都有显著的总体下降。一个值得注意的次要发现是DBT参与者在阿片类药物使用的自我报告中比CVT + 12S组明显更准确。(C) 2002爱思唯尔科学爱尔兰有限公司版权所有。
We conducted a randomized controlled trial to evaluate whether dialectical behavior therapy (DBT). a treatment that synthesizes behavioral change with radical acceptance strategies, would be more effective for heroin-dependent women with borderline personality disorder (N = 23) than Comprehensive Validation Therapy with 12-Step (CVT + 12S), a manualized approach that provided the major acceptance-based strategies used in DBT in combination with participation in 12-Step programs. In addition to psychosocial treatment, subjects also received concurrent opiate agonist therapy with adequate doses of LAAM (thrice weekly: modal dose 90/90/130 mg). Treatment lasted for 12 months. Drug use outcomes were measured via thrice-weekly urinalyses and self-report. Three major findings emerged. First. results of urinalyses indicated that both treatment conditions were effective in reducing opiate use relative to baseline. At 16 months post-randomization (4 months post-treatment). all participants had a low proportion of opiate-positive Urinalyses (27%, in DBT: 33% in CVT + 12S). With regard to between-condition differences, participants assigned to DBT maintained reductions in mean opiate use through 12 months of active treatment while those assigned to CVT+12S significantly increased opiate use during the last 4 months of treatment. Second. CVT + 12S retained all 12 participants for the entire year of treatment, compared to a 64%, retention rate in DBT. Third. at both post-treatment and at the 16-month follow-up assessment, subjects in both treatment conditions showed significant overall reductions in level of psychopathology relative to baseline. A noteworthy secondary finding was that DBT participants were significantly more accurate in their self-report of opiate use than were those assigned to CVT + 12S. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.