Amanda A. Uliaszek

Emotion regulation profiles in psychogenic non-epileptic seizures

BACKGROUND Psychogenic non-epileptic seizures (PNES) are frequently encountered in epilepsy referral centers, yet there is limited understanding of the emotion processing style in this psychiatrically heterogeneous population. Understanding profiles of emotion regulation in PNES will provide further evidence of the psychogenic nature of the disorder and will potentially inform psychotherapeutic interventions. METHODS Fifty-five patients with PNES underwent a neuropsychiatric evaluation and completed self-report questionnaires that measured difficulties in emotion regulation, psychopathology severity and quality of life. RESULTS Through the use of cluster analysis, two groups were identified; Cluster 1 represented a highly emotion dysregulated group while Cluster 2 represented a low emotion dysregulated group. Additional analyses revealed that each group significantly differed from normative data. Finally, Cluster 1 was significantly associated with several measures of psychiatric symptoms, higher rates of comorbid psychiatric diagnoses and impairment in quality of life. CONCLUSIONS These findings suggest that patients with PNES may be subject to high levels of emotion dysregulation, severe psychiatric symptomatology and impaired quality of life, or to low emotion dysregulation characterized by emotional unawareness or avoidance. These profiles clearly differ from normative data regarding emotion regulation and their identification may help tailor psychotherapeutic interventions.

Group therapy for university students: A randomized control trial of dialectical behavior therapy and positive psychotherapy.

The present study examined the efficacy of two evidence-based group treatments for significant psychopathology in university students. Fifty-four treatment-seeking participants were randomized to a semester-long dialectical behavior therapy (DBT) or positive psychotherapy (PPT) group treatment. Mixed modeling was used to assess improvement over time and group differences on variables related to symptomatology, adapative/maladaptive skill usage, and well-being/acceptability factors. All symptom and skill variables improved over the course of treatment. There were no statistically significant differences in rate of change between groups. The DBT group evidenced nearly all medium to large effect sizes for all measures from pre-to post-treatment, with mostly small to medium effect sizes for the PPT group. There was a significant difference in acceptability between treatments, with the DBT group demonstrating significantly lower attrition rates, higher attendance, and higher overall therapeutic alliance. While both groups demonstrated efficacy in this population, the DBT group appeared to be a more acceptable and efficacious treatment for implementation. Results may specifically apply to group therapy as an adjunctive treatment because a majority of participants had concurrent individual therapy.

A Pilot Intervention of Multifamily Dialectical Behavior Group Therapy in a Treatment-Seeking Adolescent Population: Effects on Teens and Their Family Members

This open pilot trial examined the feasibility of a 16-week multifamily dialectical behavior therapy (DBT) skills group adapted for a multifamily context as an addendum to treatment as usual. Psychopathology symptoms in both adolescents (N = 13) and caregivers (N = 16) were assessed pre- and posttreatment using multiple methods and reporters. There was a significant reduction in adolescent borderline and antisocial personality disorder symptoms as assessed by diagnostic interview, as well as a significant decrease in caregiver-reported adolescent internalizing and externalizing behaviors. However, adolescents did not self-report a significant decrease in symptoms. Results suggest that multifamily DBT skills group may be a feasible treatment in this population and speak to the importance of further research examining the implementation and dissemination of DBT with adolescents in a family context.

Therapeutic alliance mediates the association between personality and treatment outcome in patients with major depressive disorder.

BACKGROUND Patient personality traits have been shown to influence treatment outcome in those with major depressive disorder (MDD). The trait agreeableness, which reflects an interpersonal orientation, may affect treatment outcome via its role in the formation of therapeutic alliance. No published studies have tested this hypothesis in patients with MDD. METHOD Participants were 209 outpatients with MDD who were treated in a randomized control trial. Mediation analyses were conducted to examine the role of therapeutic alliance in the association between pretreatment personality and the reduction of depression symptom severity during treatment. Separate models were estimated for patient- versus therapist-rated therapeutic alliance. RESULTS We found a significant indirect effect of agreeableness on the reduction of depression severity via patient-rated therapeutic alliance. Results were replicated across two well-validated measures of depression symptom severity. Results also partially supported indirect effects for extraversion and openness. Therapist ratings of alliance did not mediate the association between personality and treatment outcomes. LIMITATIONS Patients were recruited as part of a randomized control trial, which may limit the generalizability of results to practice-based clinical settings. Due to constraints on statistical power, intervention-specific mediation results were not examined. CONCLUSIONS These results highlight the importance of personality and the role it plays in treatment process as well as outcome.

Distress Tolerance Skills for College Students: A Pilot Investigation of a Brief DBT Group Skills Training Program

ABSTRACT This report outlines the evaluation of a brief dialectical behavior therapy (DBT) group skills training program for students presenting with serious psychological concerns (referral reasons included suicidality, self-injury, and substance use). Students were enrolled in distress tolerance groups ranging from 7–10 weeks. The majority of the students in the sample were receiving psychiatric medication, individual therapy, or both. All students (N = 22) demonstrated significantly improved scores on measures of emotion regulation and functional and dysfunctional coping. These results are the first to show that targeted skills training with DBT mindfulness and distress tolerance skills can produce beneficial outcomes in college students in the context of a short-term intervention.

Cross-validation of the demoralization construct in the Revised NEO Personality Inventory.

Demoralization is defined as a pervasive, generalized negative emotional construct present in psychiatric disorders and a variety of medical conditions. Demoralization is also conceptualized as a ubiquitous affective-laden factor common to most forms of psychopathology that increases the magnitude of intercorrelations among putatively distinct psychiatric symptom scales (Tellegen, 1985). Using exploratory structural equation modeling to identify common variance across the revised NEO Personality Inventory (NEO PI-R), a measure of the five-factor model of personality, Noordhof, Sellbom, Eigenhuis, and Kamphuis (2015) constructed an 18-item Demoralization subscale in a Dutch-speaking sample of patients attending a clinic for personality disorders in the Netherlands. In the current study we sought to cross-validate these findings in an English-speaking and diagnostically heterogeneous sample of psychiatric patients (N = 1930) receiving consultation or treatment at a large mental health and addiction center in Canada. Our results support the construct validity of the Demoralization subscale and its capacity to account for demoralization-related variance in the NEO PI-R. We believe these findings support the general tenets of demoralization and the presence of this construct in the NEO PI-R item pool.

Mechanisms of change in group therapy for treatment-seeking university students

The present study examined mechanisms of change in dialectical behavior therapy (DBT) skills group and positive psychotherapy (PPT) group intervention, two treatments that have previously been shown to be effective at reducing symptoms of BPD and depression over a 12-week treatment protocol within the context of a college counseling center (Uliaszek et al., 2016). The present study is secondary data analysis of that trial. We hypothesized that change in dysfunctional coping skills use would be a specific mechanism for DBT, while change in functional coping skills use and therapeutic alliance would be mechanisms of change for both treatments. Fifty-four participants completed self-report and interview-based assessments at pretreatment, weeks 3, 6, 9, and posttreatment. Path models examined the predictive power of the mechanisms in predicting outcome; the moderating effect of group membership was also explored. Dysfunctional coping skills use across the course of treatment was a significant mechanism of change for BPD and depression for the DBT group, but not the PPT group. Conversely, therapeutic alliance was a significant mechanism of change for the PPT group, but not the DBT group. Findings highlight the importance of each mechanism during mid-to late-treatment specifically.