Mapping treatment components to targets in dialectical behavior therapy

将治疗成分映射到辩证行为疗法的目标

• 批准号: 10080753
• 负责人: Katherine Lee Dixon-Gordon
• 金额: $ 19.35万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-06 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10080753
• 关键词: Address; Adult; Affect; American; Arousal; Behavior; Behavioral; Biological; Borderline Personality Disorder; Caring; Characteristics; Control Groups; Data; Decision Making; Development; Dialectical behavior therapy; Disease; Effectiveness; Elements; Emotional; Emotions; Evaluation; Evidence based treatment; Functional disorder; Goals; Health system; Impairment; Impulsive Behavior; Impulsivity; Individual; Intervention; Investigational Therapies; Laboratories; Laws; Measures; Mental Health; Methods; Mission; Morbidity - disease rate; Nature; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Pilot Projects; Positioning Attribute; Problem Solving; Psychopathology; Public Health; Randomized; Recurrence; Reporting; Research; Resource Allocation; Resources; Sampling; Self Assessment; Self Destructive Behavior; Self-Injurious Behavior; Social Problems; Suicide; Symptoms; Taxes; Testing; Training Activity; United States National Institutes of Health; Work; base; behavior measurement; cost; distress tolerance; efficacious treatment; emotion dysregulation; emotion regulation; emotional symptom; experience; high risk; high risk population; improved; indexing; individualized medicine; innovation; interpersonal therapy; mindfulness; mortality; multimodality; novel; personalized medicine; response; severe mental illness; skills; skills training; societal costs; stress reactivity; stressor; treatment effect; treatment research; treatment response

PROJECT SUMMARY/ABSTRACT Borderline personality disorder (BPD) is a severe mental health condition with high morbidity and mortality. Although dialectical behavior therapy (DBT) is an efficacious treatment for BPD, it is resource-intensive and lengthy in its full form, involving one year of weekly individual therapy and group skills training in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. As a result, few patients have access to the full treatment. A better understanding of how the distinct components of DBT affect different sets of symptoms could help to streamline this treatment and personalize its use with specific patients. DBT emotion regulation skills training may be a particularly important component of DBT. Emotional dysfunction is theorized to underlie many of the problems seen in BPD, including impairments in decision- making, impulsive behaviors, and self-injury. The PI's pilot data suggest that DBT emotion regulation skills may have unique effects on emotion targets in BPD, as well as broader effects beyond emotional symptoms. Conversely, DBT interpersonal effectiveness may affect interpersonal targets. Yet this small sample pilot remains the only study to test experimentally the effects of distinct DBT skills modules. Therefore, the proposed study examines the unique effects of two distinct DBT skills training modules. Participants will be adults with BPD and recent, recurrent self-injurious behaviors (N = 81) who will be randomly assigned to six weeks of DBT emotion regulation skills training (DBT-ER), DBT interpersonal effectiveness skills training (DBT-IE), or a non-skills control group. Using innovative laboratory-based assessment methods, the proposed study will examine the effects of these conditions on emotional responding and interpersonal functioning, as well as BPD related outcomes. Aim 1 examines the unique effects of DBT-ER and DBT-IE on their respective emotion-related (subjective and biological emotional reactivity, behavioral emotion regulation, skills use) and interpersonal (subjective and behavioral) targets, compared to the control. Aim 2 examines whether DBT-ER target engagement predicts reductions in BPD symptoms and self-injury. Aim 3 examines whether baseline high emotion dysregulation predicts greater response to the DBT-ER condition versus the other conditions. The research team (PI: Dixon-Gordon, Co-I: Gratz; Consultants: Cooney, Hazlett; Collaborators: Constantino, Laws) has extensive experience in DBT, emotion regulation, biological assessment of stress reactivity, and treatment research and is therefore uniquely positioned to address these aims. The proposed research is innovative in its experimental examination of the effects of DBT components on specific targets in BPD. Given the high societal costs of BPD, this work has important public health significance. Findings will inform an R01 submission examining modular use of DBT components to result in briefer and more efficient individualized treatments for patients.

项目概要/摘要 边缘性人格障碍（BPD）是一种严重的精神健康状况，发病率和死亡率很高。 虽然辩证行为疗法（DBT）是治疗 BPD 的有效方法，但它是资源密集型的并且 其完整形式很长，包括一年的每周个人治疗和正念团体技能训练， 情绪调节、人际交往效率和抗压能力。结果，很少有患者能够获得 全面治疗。更好地了解 DBT 的不同成分如何影响不同的症状 可以帮助简化这种治疗并使其针对特定患者的使用个性化。 DBT情绪调节技能训练可能是DBT中尤为重要的组成部分。情绪化 从理论上讲，功能障碍是 BPD 中许多问题的根源，包括决策障碍。 制造、冲动行为和自残。 PI 的试点数据表明 DBT 情绪调节技能可能 对 BPD 的情绪目标有独特的影响，以及情绪症状之外的更广泛的影响。 相反，DBT 人际有效性可能会影响人际目标。然而这个小样本试点仍然存在 唯一通过实验测试不同 DBT 技能模块效果的研究。 因此，本研究探讨了两种不同的 DBT 技能培训模块的独特效果。 参与者将是患有 BPD 且最近有反复自伤行为的成年人 (N = 81)，他们将被随机分配 分配六周的 DBT 情绪调节技能培训（DBT-ER）、DBT 人际效能技能 培训（DBT-IE），或非技能对照组。使用基于实验室的创新评估方法， 拟议的研究将检查这些条件对情绪反应和人际交往的影响 功能，以及 BPD 相关结果。目标 1 检查 DBT-ER 和 DBT-IE 对 他们各自的情绪相关（主观和生物情绪反应、行为情绪调节、 与对照相比，技能使用）和人际（主观和行为）目标。目标 2 检查 DBT-ER 目标参与是否可以预测 BPD 症状和自伤的减少。目标 3 检查 基线高度情绪失调是否预示着对 DBT-ER 病症的反应比其他病症更大 状况。 研究团队（PI：Dixon-Gordon，Co-I：Gratz；顾问：Cooney、Hazlett；合作者： Constantino, Laws）在 DBT、情绪调节、压力生物评估方面拥有丰富的经验 反应性和治疗研究，因此具有独特的地位来实现这些目标。 所提出的研究在实验检查 DBT 成分对人体的影响方面具有创新性。 BPD 中的具体目标。鉴于 BPD 的高昂社会成本，这项工作具有重要的公共卫生意义。 研究结果将告知 R01 提交材料，审查 DBT 组件的模块化使用，以产生更简短、更详细的结果 为患者提供高效的个体化治疗。