Milton Z. Brown

Suicide Attempt Self-Injury Interview (SASII): Development, Reliability, and Validity of a Scale to Assess Suicide Attempts and Intentional Self-Injury.

The authors describe the development of the Suicide Attempt Self-Injury Interview (SASII), an instrument designed to assess the factors involved in nonfatal suicide attempts and intentional self-injury. Using 4 cohorts of participants, authors generated SASII items and evaluated them with factor and content analyses and internal consistency statistics. The final measure was assessed for reliability and validity with collateral measures. The SASII assesses variables related to method, lethality and impulsivity of the act, likelihood of rescue, suicide intent or ambivalence and other motivations, consequences, and habitual self-injury. The SASII was found to have very good interrater reliability and adequate validity.

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.

Shame as a prospective predictor of self-inflicted injury in borderline personality disorder: a multi-modal analysis.

The primary aim of this study was to examine the prospective association of shame with self-inflicted injury (SII), including suicide attempts and nonsuicidal self-injury, among women with borderline personality disorder (BPD) who were enrolled in a clinical trial (N = 77). A multi-method approach was used to assess self-reported shame, nonverbal shame behaviors, and assessor ratings of shame during an interview regarding antecedents for a recent episode of SII. Higher levels of nonverbal shame behaviors predicted a higher likelihood of subsequent SII, and shorter time to SII, after controlling for past SII as well as other emotions associated with SII. Self-reported state shame and assessor ratings of shame were associated with prospective SII, but not after controlling for other emotions. These findings underscore the important role of shame in SII, particularly shame in the presence of contextual prompts for events that surround episodes of SII.

Sexually transmitted disease rates and high-risk sexual behaviors in borderline personality disorder versus borderline personality disorder with substance use disorder.

We examined the rates of sexually transmitted diseases (STDs) in women with borderline personality disorder (BPD) (using PDE and SCID-II) and substance abuse or dependence (SCID-I) (BPD-SUD) (N = 82) compared with those with BPD-only (N = 102), exploring mediators of this relationship. Participants were interviewed about STD history (gonorrhea, genital herpes, syphilis, trichomonas, human papillomavirus, and HIV), condom use, number of sexual partners, poverty, and prostitution. BPD-SUD appeared to be particularly at high risk for STDs, reporting significantly more STDs than BPD (F[1,172]= 11.74, p = 0.001, d =.27), particularly for gonorrhea, trichomonas, and human papillomavirus. The relationship between BPD-SUD and STDs is mediated by poverty, prostitution in the last year, recent unprotected sex with two or more partners, and >20 lifetime partners (z = –2.16 which is p= 0.03), with prostitution alone making a significant contribution to this relationship (z = –2.49, p = 0.01).

Heart rate variability as a marker of self-regulation.

Self-regulation is central to many of the most important individual and societal problems today. We sought to determine whether the relationship between self-regulation and heart rate variability (HRV) could be replicated and extended. We hypothesized that baseline HRV would predict persistence on an anagram task, and that under conditions requiring greater self-control, HRV would increase. Two groups were given the same set of difficult and unsolvable anagrams. To induce self-regulatory fatigue, the suppression group was asked to try to not think of a white bear while the expression group was asked to try to think of a white bear. Baseline HRV predicted persistence on the unsolvable anagram. Both groups demonstrated changes in HRV relative to baseline, although we were unable to replicate findings that HRV was elevated during high self-regulatory effort. We were, however, able to replicate findings that the expression group persisted longer on the anagram task compared to the suppression group but only when accounting for physical activity scores. The present study advances our knowledge of the relationship between HRV and self-regulation, so that we can more successfully treat those with seriously impaired self-control.

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.

A comparison of borderline personality disorder with and without eating disorders

This study examines the degree to which an eating disorder (ED) is associated with the recurrence and severity of suicide attempts, non-suicidal self-injury, rates of co-occurring Axis I and II disorders, and psychosocial functioning among Borderline Personality Disorder (BPD) outpatients. A group of 135 treatment-seeking women with BPD were assessed using structured clinical interviews. BPD was assessed using the International Personality Disorders Examination, confirmed by the Structured Clinical Interview for DSM-IV (SCID)-II, and Axis I disorders were assessed with the SCID I. A total of 17.8% of the sample met criteria for a current ED, with 6.7% meeting criteria for Anorexia Nervosa (AN), 5.9% for Bulimia Nervosa (BN), and 5.2% for Binge-Eating Disorder (BED). In this BPD sample, in the last year, current BN was associated with a significantly greater risk of recurrent suicide attempts while current AN was associated with increased risk of recurrent non-suicidal self-injury. BPD with current AN or BED was associated with a greater number of non-ED current Axis I disorders. Further replication of these results is needed. Women with BPD must be assessed for AN and BN as these diagnoses may confer greater risk for suicidal and self-injurious behavior and may have to be prioritized in treatment.

The effect of hypnotic suggestion on spinal cord injury pain

Chronic pain is a significant concern for many individuals with spinal cord injury (SCI). However, few effective treatments have been found for SCI-related pain. The current study sought to explore whether persons with SCI-related pain would respond to hypnotic suggestion for pain relief, and to examine possible moderators of this response. Twenty-two individuals with SCI-related pain rated their 6-month average and least pain on 0‐10 scales of pain intensity. They also rated their current pain intensity and pain unpleasantness on 0‐10 scales at eight subsequent time points: immediately before a hypnotic induction, immediately after the induction, after each of five hypnotic suggestions, and at the end of the entire session after awakening. Eighty-six percent of the participants reported decreases in pain intensity and pain unpleasantness from pre-induction to post-induction. Significant omnibus analyses of variance followed by pairwise comparisons indicated statistically significant decreases in pain intensity and unpleasantness from pre-to post induction for both pain intensity and pain unpleasantness, and an additional decrease in pain intensity following the analgesia suggestion. In addition, although not specifically suggested, the decrease in pain that subjects experienced during the hypnotic session persisted after they were instructed to awaken. The ability of the subjects to decrease pain intensity to levels lower than the least pain they had experienced during the past six months was associated with hypnotic responsiveness, while the decrease in pain intensity from pre-induction to post-analgesia suggestion was associated with 6-month average pain. These preliminary findings indicate that hypnotic interventions have the potential to benefit many individuals with SCI-related pain, and that controlled trials of hypnotic analgesia with this population are warranted.

Stopping Self-Harm Once and for All: Relapse Prevention in Dialectical Behavior Therapy

Publisher Summary This chapter provides an overview of the issues and strategies associated with preventing the relapse of deliberate self-harm (DSH). DSH involves direct destruction or alteration of ones body tissue with the intent to cause harm, but without conscious intent to die. Dialectical behavior therapy (DBT) originally represented an attempt to apply established behavioral and cognitive therapy techniques to the treatment of individuals with chronic suicidal behavior s and self-injury. The acceptance and change-based interventions in DBT are the building blocks of a comprehensive treatment that aims to address several key functions. It is found that although many DBT interventions target emotion vulnerability and regulation, vulnerability to emotions may persist beyond the end of treatment and continue to place persons with BPD at risk for relapse. Research suggests that negative emotion is one of the key factors contributing to relapse for both substance abuses. The basic procedure of exposure and response-prevention involves exposing the patient to stimuli that elicit emotional responses and blocking behaviors that function to escape from those stimuli. The reduction in emotion vulnerability through self-care and positive activities is also elaborated.