Linda A. Dimeff

Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment

This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence

A randomized clinical trial was conducted to evaluate whether Dialectical Behavior Therapy (DBT), an effective cognitive-behavioral treatment for suicidal individuals with borderline personality disorder (BPD), would also be effective for drug-dependent women with BPD when compared with treatment-as-usual (TAU) in the community. Subjects were randomly assigned to either DBT or TAU for a year of treatment. Subjects were assessed at 4, 8, and 12 months, and at a 16-month follow-up. Subjects assigned to DBT had significantly greater reductions in drug abuse measured both by structured interviews and urinalyses throughout the treatment year and at follow-up than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU. DBT has been shown to be more effective than treatment-as-usual in treating drug abuse in this study, providing more support for DBT as an effective treatment for severely dysfunctional BPD patients across a range of presenting problems.

Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder

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.

Through Her Eyes Factors Affecting Women's Perception of and Resistance to Acquaintance Sexual Aggression Threat

A major component of a womans ability to resist assaults by strangers versus acquaintances lies in the social and cognitive context in which she is engaged with the perpetrator and within which she must recognize potential threat before engaging in a behavioral response. This paper presents questionnaire and focus group findings of heterosexual college sorority womens social contexts, perceived risks, responses, and psychological barriers to protecting themselves from sexual aggression threat by fraternity acquaintances. Several social and cognitive factors, including alcohol consumption and psychological barriers, were related to projected responses to sexual aggression. Participants in general held a high sense of invulnerability to victimization and an optimistic belief in their ability to resist sexual aggression. Several differences between previously victimized and nonvictimized women also emerged.

A Pilot Study of the DBT Coach: An Interactive Mobile Phone Application for Individuals with Borderline Personality Disorder and Substance Use Disorder

Dialectical behavior therapy (DBT) has received strong empirical support and is practiced widely as a treatment for borderline personality disorder (BPD) and BPD with comorbid substance use disorders (BPD-SUD). Therapeutic success in DBT requires that individuals generalize newly acquired skills to their natural environment. However, there have been only a limited number of options available to achieve this end. The primary goal of this research was to develop and test the feasibility of the DBT Coach, a software application for a smartphone, designed specifically to enhance generalization of a specific DBT skill (opposite action) among individuals with BPD-SUD. We conducted a quasiexperimental study in which 22 individuals who were enrolled in DBT treatment programs received a smartphone with the DBT Coach for 10 to 14 days and were instructed to use it as needed. Participants used the DBT Coach an average of nearly 15 times and gave high ratings of helpfulness and usability. Results indicate that both emotion intensity and urges to use substances significantly decreased within each coaching session. Furthermore, over the trial period, participants reported a decrease in depression and general distress. Mobile technology offering in vivo skills coaching may be a useful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior.

Dialectical behavior therapy and the treatment of emotion dysregulation

Borderline personality disorder (BPD) is a disorder characterized by severe disturbances in emotion regulation. In Dialectical Behavior Therapy (DBT), affect dysregulation is seen as a consequence of a transaction between a biological predisposition to emotion vulnerability and invalidating environmental experiences. In the past few years, a growing body of research has accumulated demonstrating the efficacy of DBT in treating severely disordered, chronically suicidal, and substance-dependent individuals with BPD. This article describes a DBT approach to the treatment of emotion regulation in individuals with BPD.

Dialectical behavior therapy for substance abuse: A pilot application to methamphetamine-dependent women with borderline personality disorder

The primary aim of this paper is to describe key modifications made to standard Dialectical Behavior Therapy (DBT) for use with substance-dependent individuals with borderline personality disorder (BPD). Key modifications include application of dialectics to issues surrounding abstinence, a new set of substance abuse behavioral targets, a set of attachment strategies for difficult-to-engage and easily lost clients, and modification of some skills geared for substance abusing clients. Treatment outcome findings from a small 12-month uncontrolled pilot trial of DBT for methamphetamine-dependent women with BPD are presented. Of the 3 participants who commenced treatment, 2 completed treatment and were abstinent from use of all illicit drugs by 6 months; results were maintained for the duration of the assessment period 6 months later. These encouraging results suggest that DBT may hold promise for treating methamphetamine dependence.

Expectations regarding acquaintance sexual aggression among sorority and fraternity members

Among women, college is a high risk period for sexual assault by male acquaintances. Differences in expectations held by men and women may contribute to misinterpretation of social cues and subsequent sexual aggression and may impair womens ability to respond effectively. This paper presents findings from a predominantly Caucasian sample (85.9%) of college sorority (n = 66) and fraternity (n = 34) members regarding the social context within which they interact and their expectations regarding perpetration of and response to sexual aggression. Results showed differences in mens and womens expectations and responses, and in particular highlighted how mens expectations were related to womens resistance of unwanted sex. Understanding the cognitive processes that men and women draw upon in social interactions can be useful for developing sexual aggression prevention and resistance interventions.

Computer-enhanced primary care practitioner advice for high-risk college drinkers in a student primary health-care setting *

Heavy drinking among college students remains a significant public health concern. Studies of a brief intervention for high-risk college drinkers developed by Alan Marlatt and colleagues have produced promising results. This current study sought to extend this earlier work by developing a streamlined version for use at a student health center. Undergraduate students seeking services at a student health center were asked to complete the Multi-Media Assessment of Student Health (MMASH), an interactive computer program developed for purposes of this study. Students meeting high-risk criteria for heavy or hazardous drinking were invited to participate in the research program. Forty-one students volunteered to participate and were randomly assigned by MMASH to either the brief intervention experimental condition or a treatment-as-usual control condition. Immediately following completion of MMASH, experimental participants and their primary care practitioner received and reviewed a personalized graphic feedback from an attached printer that summarized their drinking habits, risks, and encouraged moderate drinking. Moderate to large treatment effect sizes favoring the brief intervention were observed on self-report measures of binge drinking episodes and alcohol problems at the 30-day follow-up. Statistically significant gains were observed among those participants receiving the most exposure to the intervention in comparison to those who received less exposure.

Predicting adoption of exposure therapy in a randomized controlled dissemination trial.

The present study examined organizational, client, and therapist characteristics as predictors of use of and proficiency in exposure therapy (ET) after training. Therapists naïve to ET (N=181) were randomized to: (1) online training (OLT), (2) OLT plus motivational enhancement (ME), or (3) OLT+ME plus a learning community. Twelve weeks after training, self-reported use of ET in clinical practice was high (87.5%) and therapists demonstrated moderate clinical proficiency. Use of ET was predicted by therapist degree, self-efficacy, and knowledge. Clinical proficiency was predicted by therapist anxiety sensitivity, attitudes, and knowledge, as well as organizational and client barriers. Several of these effects were moderated by training condition, indicating that therapists who received more comprehensive training were less impacted by barriers and showed enhanced adoption in the presence of facilitating factors. Overall, these results suggest that the primary barriers to the adoption of ET are therapist, not organizational or client, factors.