Ryan Barnhart

A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder

Evidence‐based therapies for borderline personality disorder (BPD) are lengthy and scarce. Data on brief interventions are limited, and their role in the treatment of BPD is unclear. Our aim was therefore to evaluate the clinical effectiveness of brief dialectical behaviour therapy (DBT) skills training as an adjunctive intervention for high suicide risk in patients with BPD.

Outcome Trajectories among Homeless Individuals with Mental Disorders in a Multisite Randomised Controlled Trial of Housing First

Purpose: Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. Methods: Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. Results: In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajectories included gender, age, prior month income, Aboriginal status, total time homeless, previous hospitalizations, overall health, psychiatric symptoms, and comorbidity, while others such as education, diagnosis, and substance use problems did not. Conclusion: While the observed patterns and their predictors are of interest for further research and general service planning, no set of variables is yet known that can accurately predict the likelihood of particular individuals benefiting from HF programs at the outset.

Narrative flexibility in brief psychotherapy for depression

Abstract Objective: This study aimed to further understand how narrative flexibility contributes to therapeutic outcome in brief psychotherapy for depression utilizing the Narrative-Emotion Process Coding System (NEPCS), an observational measure that identifies specific markers of narrative and emotion integration in therapy sessions. Method: The present study investigated narrative flexibility by examining the contribution of NEPCS shifting (i.e., movement between NEPCS markers) in early, middle, and late sessions of client-centred therapy (CCT), emotion-focused therapy (EFT), and cognitive therapy (CT) and treatment outcome (recovered versus unchanged at the therapy termination). A logistic regression, with Wald tests of parameter estimates and pairwise comparisons, was used to test the study hypotheses. Results: Results demonstrated that for recovered clients, the probability of shifting over the course of a therapy session was constant, whereas the probability of shifting declined for unchanged clients as the session progressed. There was also evidence that longer duration of time spent in any single NEPCS marker was negatively associated with shifting for both recovered and unchanged clients, although the effect was stronger for unchanged clients. Conclusions: The results provided preliminary support for the contribution of narrative flexibility to treatment outcomes in EFT, CCT, and CT treatments of depression.

Happiness vs. mindfulness exercises for individuals vulnerable to depression

An online ‘positivity’ exercise involving the practice of discrete positive emotions was pitted against a mindfulness meditation exercise and an active placebo control. The effects of positivity and meditation were examined in relationship to personality variables known to entail vulnerability to depression. Participants (N = 741) were randomly assigned to the positivity, mindfulness, or control condition. They completed their exercise for three weeks and were assessed on measures of subjective well-being at baseline, post-test, and one, and two months later. Results indicated that all groups showed significant decreases in depressive symptoms from baseline to two months. The positivity exercise uniquely predicted increases in meaning, pleasure, engagement, and satisfaction in life across follow-ups. Dependent individuals responded favorably to the positivity intervention in the short run, but worsened in the long run for pleasure-related happiness. Self-criticism was associated with significantly greater gains in life satisfaction following exercise completion.

The influence of posttraumatic stress disorder on treatment outcomes of patients with borderline personality disorder

The aim of this study was to determine the influence of posttraumatic stress disorder (PTSD) on treatment outcomes in patients with borderline personality disorder (BPD). Participants were 180 individuals diagnosed with BPD enrolled in a randomized controlled trial that compared the clinical and cost effectiveness of dialectical behavior therapy (DBT) and general psychiatric management (GPM). Multilevel linear models and generalized linear models were used to compare clinical outcomes of BPD patients with and without PTSD. BPD patients with comorbid PTSD reported significantly higher levels of global psychological distress at baseline and end of treatment compared to their non-PTSD counterparts. Both groups evidenced comparable rates of change on suicide attempts and non-suicidal self-injury (NSSI), global psychological distress, and BPD symptoms over the course of treatment and post-treatment follow-up. DBT and GPM were effective for BPD patients with and without PTSD across a broad range of outcomes.

Alliance Rupture and Resolution in Dialectical Behavior Therapy for Borderline Personality Disorder

The aim of this exploratory study was to investigate alliance rupture and resolution processes in the early sessions of a sample of clients who underwent 1 year of standard dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Participants were three recovered and three unrecovered clients drawn from the DBT arm of a randomized controlled trial that compared the clinical and cost-effectiveness of DBT and general psychiatric management. Alliance rupture and resolution processes were coded using the observer-based Rupture Resolution Rating Scale. Unrecovered clients evidenced a higher frequency of withdrawal ruptures than recovered clients. Withdrawal ruptures tended to persist for unrecovered clients despite the degree of resolution in the prior session, unlike for recovered clients, for whom the probability of withdrawal ruptures decreased as the degree of resolution increased. This study suggests that alliance rupture and resolution processes in early treatment differ between recovered and unrecovered clients in DBT for BPD.

Outcome Trajectories and Prognostic Factors for Suicide and Self-Harm Behaviors in Patients With Borderline Personality Disorder Following One Year of Outpatient Psychotherapy

This study examined suicide and self-harm trajectories in 180 individuals with BPD receiving dialectical behavior therapy or general psychiatric management in a randomized controlled trial. Suicide and self-harm behaviors were assessed at baseline, every four months throughout treatment, and every 6 months over 2 years of follow-up. Latent class growth mixture modeling identified suicide and self-harm trajectories. Multinomial logistic regression analyses examined baseline patient characteristics. Three latent subgroups were identified. The largest responded rapidly to treatment and sustained a favorable response post-discharge. The second progressed slowly during treatment but achieved and maintained a favorable response. A third subgroup showed a rapid favorable response during treatment, however symptoms returned to near baseline levels post-discharge. This third subgroup had higher baseline depression, emergency department visits, and unemployment. BPD patients with high baseline health care utilization, depression, and unemployment may benefit from modifications to treatment specifically targeting these issues.

Acts of kindness reduce depression in individuals low on agreeableness.

Low Agreeableness is a personality dimension involving hostility, antagonistic behaviors, and the propensity for conflict. Within the repertoire of positive psychology interventions, the practice of compassion may be a particularly redemptive for these individuals given their deficits in this domain. Helping has previously been found to boosts momentary positive affect in nonaltruists (Conway, Rogelberg, & Pitts, 2009). Consequently, we hypothesized that individuals low on trait Agreeableness would report greater benefits from compassion interventions, including reductions in depression and increases in life satisfaction. Two compassion exercises were investigated: (a) a loving-kindness meditation (LKM) exercise, and (b) an acts of kindness exercise. These were compared with a control condition involving the journaling of interpersonal relationships. Participants were drawn from an international sample (N = 648) and were randomly assigned to one of the 3 conditions. All groups completed their exercise online every other day for 3 weeks. Trait Agreeableness was assessed at baseline with the Big Five Inventory (John & Srivastava, 1999). Measures of depression and life satisfaction were administered at baseline, at posttest, and 1 and 2 months later at follow-up assessments. Findings showed that participants in both experimental conditions (LKM and Acts of Kindness) reported significant reductions in depression at posttest compared with those in the control condition. Personality also interacted with exercise condition such that those low on Agreeableness doing acts of kindness reported the greatest reductions in depression, and increases in life satisfaction at 2 months, compared with those in the LKM and control conditions.

Predictors of Dropout From a 20-Week Dialectical Behavior Therapy Skills Group for Suicidal Behaviors and Borderline Personality Disorder

Treatment dropout among individuals with borderline personality disorder (BPD) is associated with negative psychosocial outcomes. Identifying predictors of dropout among this population is critical to understanding how to improve treatment retention. The present study extends the current literature by examining both static and dynamic predictors of dropout. Chronically suicidal outpatients diagnosed with BPD (N = 42) were randomly assigned to a 20-week dialectical behavior therapy (DBT) skills training group. Static and dynamic predictors were assessed at baseline, 5, 10, 15, 20 weeks, and 3 months post-intervention. A post-hoc two-stage logistic regression analysis was conducted to predict dropout propensity. Receiving disability benefits at baseline and decreases in mindfulness were associated with significantly increased probability of dropout. Clinicians working with chronically self-harming outpatients diagnosed with BPD would benefit from prioritizing clinical interventions that enhance mindfulness in order to decrease dropout propensity.