Jennifer Q. Morse

Efficacy of Dialectical Behavior Therapy in Women Veterans With Borderline Personality Disorder

Twenty women veterans who met criteria for borderline personality disorder (BPD) were randomly assigned to Dialectical Behavior Therapy (DBT) or to treatment as usual (TAU) for 6 months. Compared with patients in TAU, those in DBT reported significantly greater decreases in suicidal ideation, hopelessness, depression, and anger expression. In addition, only patients in DBT demonstrated significant decreases in number of parasuicidal acts, anger experienced but not expressed, and dissociation, and a strong trend on number of hospitalizations, although treatment group differences were not statistically significant on these variables. Patients in both conditions reported significant decreases in depressive symptoms and in number of BPD criterion behavior patterns, but no decrease in anxiety. Results of this pilot study suggest that DBT can be provided effectively independent of the treatments developer, and that larger efficacy and effectiveness studies are warranted.

Sexual orientation and adolescent substance use : a meta-analysis and methodological review

AIMS Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. METHODS Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. RESULTS LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohens d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. CONCLUSIONS The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

Dialectical behavior therapy for depressed older adults: a randomized pilot study

OBJECTIVE Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. METHODS They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). RESULTS Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. CONCLUSION Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.

A mediational model relating affect intensity, emotion inhibition, and psychological distress

A growing empirical literature suggests that attempts to suppress, inhibit, or avoid private experience (e.g., thoughts, feelings) can be problematic. The purpose of this study was to examine a model in which inhibition of thoughts and emotion was predicted to mediate the relationship between the trait of negative affect intensity and acute psychological distress. Two studies evaluated the model using structural equation modeling procedures: one in a clinical sample and the other in a nonclinical sample. Support for the model was found in both studies, indicating its generalizability. These results provide further evidence for the notion that avoiding or inhibiting cognitive and emotional experience may be a particularly problematic coping style, which is more likely to be engaged in by emotionally intense individuals who are vulnerable to psychological distress.

A model predicting suicidal ideation and hopelessness in depressed older adults: The impact of emotion inhibition and affect intensity

The purpose of this study was to begin a preliminary examination of constructs theorized to be related to suicidal behavior by testing a model of the influence of both temperament and emotion regulation on suicidal ideation and hopelessness in a sample of depressed older adults. The model was evaluated using structural equation modeling procedures in a sample of depressed, older adults. Findings supported a temporally predictive model in which negative affect intensity and reactivity lead to emotion inhibition, operationalized as ambivalence over emotional expression and thought suppression, which in turn lead to increased presence of suicidal predictors, operationalized as hopelessness and suicidal ideation. These results suggest that suicide prevention efforts in older adults may be improved by targeting emotion inhibition in treatment, especially among affectively intense and reactive older adults.

When the solution is part of the problem: problem solving in elderly suicide attempters

Depression, loss, and physical illness are associated with suicide in the elderly. However, the nature of individual vulnerability remains poorly understood. Poor problem solving has been suggested as a risk factor for suicide in younger adults. Unresolved problems may create an accumulation of stressors. Thus, those with perceived deficits in problem‐solving ability may be predisposed to suicidal behavior. To test this hypothesis, we investigated whether elderly suicide attempters perceived their problem solving as deficient.

Alone? Perceived social support and chronic interpersonal difficulties in suicidal elders.

BACKGROUND Social networks may protect depressed elders against suicidal behavior. However, conflict in important relationships may undermine the sense of social support, potentially negating the protective effects. Thus, we investigated the role of chronic interpersonal difficulties and perceived social support in depressed elders with and without suicidal thoughts and attempts. METHODS 106 individuals aged 60 years and older participated in this cross-sectional, case-control study. They were placed in three groups: suicidal depressed, non-suicidal depressed and non-depressed. Following a detailed clinical characterization, we assessed perceived social support (Interpersonal Support Evaluation List), and chronic interpersonal difficulties (Inventory of Interpersonal Problems). Using general linear models, we explored the relationship between suicidal thoughts/attempts, social support, and chronic interpersonal difficulties. We also examined whether lower perceived social support explained the relationship between chronic interpersonal difficulties and suicidal thoughts/attempts. RESULTS Suicidal depressed elders reported the lowest levels of perceived social support (belonging, tangible support, and self-esteem) and higher levels of chronic interpersonal difficulties (struggle against others and interpersonal hostility), compared to both non-suicidal depressed and non-depressed elders. The relationship between chronic interpersonal difficulties and suicidal behavior was partially explained by low perceived social support. CONCLUSIONS The experience of strong affects, interpersonal struggle, and hostility in relationships may undermine the sense of social support in depressed elders, possibly leading them to contemplate or attempt suicide. Depressed elders with a history of interpersonal difficulties need to be carefully monitored for suicidal behavior.

Content validity in the PROMIS social health domain: a qualitative analysis of focus group data

PurposeOur aim was to assess the content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) social health item banks by comparing a prespecified conceptual model with concepts that focus-group participants identified as important social-health-related outcomes. These data will inform the process of improving health-related quality-of-life measures.MethodsTwenty-five patients with a range of social limitations due to chronic health conditions were recruited at two sites; four focus groups were conducted. Raters independently classified participants’ statements using a hierarchical, nested schema that included health-related outcomes, role performance, role satisfaction, family/friends, work, and leisure.ResultsKey themes that emerged were fulfilling both family and work responsibilities and the distinction between activities done out of responsibility versus enjoyment. Although focus-group participants identified volunteerism and pet ownership as important social-health-related concepts, these were not in our original conceptual model. The concept of satisfaction was often found to overlap with the concept of performance.ConclusionOur conceptual model appears comprehensive but is being further refined to more appropriately (a) distinguish between responsibilities versus discretionary activities, and (b) situate the outcome of satisfaction as it relates to impairment in social and other domains of health.

Interpersonal and emotional experiences of social interactions in borderline personality disorder.

General Aim: We examined interpersonal experiences of patients with borderline personality disorder (BPD) using a time-contingent diary procedure to collect information about social interactions for 7 days. Method: We examined the (1) quantity of social interactions and (2) interpersonal and emotional experiences during social interactions for patients with BPD (BPD; N = 42) compared with those with another personality disorder (OPD; N = 46) and those without significant personality pathology (NOPD; N = 23). Results: Results suggested that BPD patients have fewer social contacts compared with those in the NOPD group. Additionally, the BPD patients characterized their social interactions as more disagreeable, ambivalent, angry, empty, and sad compared with the OPD and NOPD groups. BPD patients reported experiencing more anxiety and less positive affect compared with the NOPD but not the OPD group. Conclusion: These findings highlight aspects of day-to-day interpersonal functioning that are specific to BPD.

Using clinician-rated five-factor model data to score the DSM-IV personality disorders.

Proposals suggest that many or all of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders (PDs) may be omitted from the DSM (5th ed.; DSM–V) and replaced with a dimensional trait model of personality pathology (Krueger, Skodol, Livesley, Shrout, & Huang, 2007; Skodol, 2009). Several authors have expressed concerns that this may be difficult for clinicians and researchers who are more comfortable with the extant PD diagnoses. In this study, we tested whether clinician ratings of traits from the Five-factor model (FFM; Costa & McCrae, 1990) can be used to recreate DSM–IV PDs. Using a sample of 130 clinical outpatients, we tested the convergent and discriminant validity of the FFM PD counts in relation to consensus ratings of the DSM–IV PDs. We then examined whether the FFM and DSM–IV PD scores correlate in similar ways with self-reported personality traits from the Schedule for Nonadaptive and Adaptive Personality (Clark, 1993). Finally, we tested the clinical utility of the FFM PD counts in relation to functional impairment. Overall, the FFM PD counts, scored using clinician ratings of the FFM traits, appeared to function like the DSM–IV PDs, thus suggesting that the use of a dimensional trait model of personality in the DSM–V may still allow for an assessment of the DSM–IV PD constructs.