Mapping treatment components to targets in dialectical behavior therapy

项目摘要/摘要 边缘型人格障碍(BPD)是一种发病率和死亡率都很高的严重的心理健康问题。 虽然辩证行为疗法(DBT)是治疗BPD的一种有效方法，但它是一种资源密集型和 完整形式的冗长，包括一年的每周个人治疗和正念的集体技能训练， 情绪调节、人际效能和痛苦容忍度。因此，很少有患者能够接触到 全面的治疗。更好地了解DBT的不同组成部分如何影响不同的症状集 可以帮助简化这种治疗，并使其在特定患者中的使用个性化。 DBT情绪调节技能训练可能是DBT的一个特别重要的组成部分。情绪化 功能障碍被认为是BPD中许多问题的基础，包括决策障碍- 制造、冲动行为和自我伤害。PI的试点数据表明，DBT情绪调节技能可能 对BPD中的情绪目标有独特的影响，以及超越情绪症状的更广泛的影响。 反之，DBT人际效能可能会影响人际目标。然而，这个小样本飞行员仍然 这是唯一一项通过实验测试不同DBT技能模块效果的研究。 因此，这项拟议的研究考察了两个不同的DBT技能培训模块的独特效果。 参与者将是患有BPD和最近反复发生的自伤行为的成年人(N=81)，他们将被随机 被分配到为期六周的DBT情绪调节技能培训(DBT-ER)，DBT人际效能技能 培训(DBT-IE)或非技能控制组。使用创新的基于实验室的评估方法， 建议的研究将考察这些情况对情绪反应和人际关系的影响。 功能，以及与BPD相关的结果。目的1研究DBT-ER和DBT-IE的独特效应 他们各自的情绪相关(主观和生物情绪反应，行为情绪调节， 技能使用)和人际(主观和行为)目标，与对照组相比。AIM 2考试 DBT-ER目标参与是否预示BPD症状和自我伤害的减少。AIM 3考试 基线高情绪调节障碍是否预示着对DBT-ER状况的更大反应 条件。 研究团队(PI：Dixon-Gordon，Co-I：Gratz；顾问：Cooney，Hazlett；合作者： 康斯坦蒂诺，劳斯)在DBT、情绪调节、生物压力评估方面拥有丰富的经验 反应性和治疗研究，因此在实现这些目标方面具有得天独厚的优势。 这项拟议的研究在对DBT组件影响的实验检验方面具有创新性 以BPD为单位的具体目标。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。 调查结果将为R01提交的检查DBT组件的模块化使用提供依据，以实现更简短和更多 为患者提供高效的个性化治疗。

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.