Mapping treatment components to targets in dialectical behavior therapy

将治疗成分映射到辩证行为疗法的目标

• 批准号: 9895561
• 负责人: Katherine Lee Dixon-Gordon
• 金额: $ 24.27万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-06 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895561
• 关键词: Address; Adult; Affect; American; Arousal; Behavior; Behavioral; Biological; Borderline Personality Disorder; Caring; Characteristics; Control Groups; Data; Decision Making; Development; Dialectical behavior therapy; Disease; Effectiveness; Elements; Emotional; Emotions; Estrogen receptor positive; Evaluation; Evidence based treatment; Functional disorder; Goals; Health system; Impairment; Impulsive Behavior; Impulsivity; Individual; Intervention; Investigational Therapies; Laboratories; Laws; Measures; Mental Health; Methods; Mission; Morbidity - disease rate; Nature; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Pilot Projects; Positioning Attribute; Problem Solving; Psychopathology; Public Health; Randomized; Recurrence; Reporting; Research; Resource Allocation; Resources; Sampling; Self Assessment; Self Destructive Behavior; Self-Injurious Behavior; Social Problems; Suicide; Symptoms; Taxes; Testing; Training Activity; United States National Institutes of Health; Work; base; behavior measurement; cost; distress tolerance; emotion dysregulation; emotion regulation; emotional symptom; experience; high risk; high risk population; improved; indexing; individualized medicine; innovation; interpersonal therapy; mindfulness; mortality; multimodality; novel; personalized medicine; response; severe mental illness; skills; skills training; societal costs; stress reactivity; stressor; treatment effect; treatment research; treatment response

PROJECT SUMMARY/ABSTRACT Borderline personality disorder (BPD) is a severe mental health condition with high morbidity and mortality. Although dialectical behavior therapy (DBT) is an efficacious treatment for BPD, it is resource-intensive and lengthy in its full form, involving one year of weekly individual therapy and group skills training in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. As a result, few patients have access to the full treatment. A better understanding of how the distinct components of DBT affect different sets of symptoms could help to streamline this treatment and personalize its use with specific patients. DBT emotion regulation skills training may be a particularly important component of DBT. Emotional dysfunction is theorized to underlie many of the problems seen in BPD, including impairments in decision- making, impulsive behaviors, and self-injury. The PI's pilot data suggest that DBT emotion regulation skills may have unique effects on emotion targets in BPD, as well as broader effects beyond emotional symptoms. Conversely, DBT interpersonal effectiveness may affect interpersonal targets. Yet this small sample pilot remains the only study to test experimentally the effects of distinct DBT skills modules. Therefore, the proposed study examines the unique effects of two distinct DBT skills training modules. Participants will be adults with BPD and recent, recurrent self-injurious behaviors (N = 81) who will be randomly assigned to six weeks of DBT emotion regulation skills training (DBT-ER), DBT interpersonal effectiveness skills training (DBT-IE), or a non-skills control group. Using innovative laboratory-based assessment methods, the proposed study will examine the effects of these conditions on emotional responding and interpersonal functioning, as well as BPD related outcomes. Aim 1 examines the unique effects of DBT-ER and DBT-IE on their respective emotion-related (subjective and biological emotional reactivity, behavioral emotion regulation, skills use) and interpersonal (subjective and behavioral) targets, compared to the control. Aim 2 examines whether DBT-ER target engagement predicts reductions in BPD symptoms and self-injury. Aim 3 examines whether baseline high emotion dysregulation predicts greater response to the DBT-ER condition versus the other conditions. The research team (PI: Dixon-Gordon, Co-I: Gratz; Consultants: Cooney, Hazlett; Collaborators: Constantino, Laws) has extensive experience in DBT, emotion regulation, biological assessment of stress reactivity, and treatment research and is therefore uniquely positioned to address these aims. The proposed research is innovative in its experimental examination of the effects of DBT components on specific targets in BPD. Given the high societal costs of BPD, this work has important public health significance. Findings will inform an R01 submission examining modular use of DBT components to result in briefer and more efficient individualized treatments for patients.

项目摘要/摘要 边缘性人格障碍（BPD）是一种严重的心理健康状况，发病率和死亡率很高。 尽管辩证行为疗法（DBT）是BPD的有效治疗方法，但它是资源密集型的 冗长的形式冗长，涉及每周一次的个人治疗和小组技能培训的正念， 情绪调节，人际关系有效性和遇险宽容。结果，很少有患者可以使用 完整的治疗。更好地理解DBT的不同组成部分如何影响不同的症状集 可以帮助简化这种治疗方法并个性化与特定患者的使用。 DBT情绪调节技能培训可能是DBT的特别重要组成部分。情绪化 理论上认为功能障碍是BPD中许多问题的基础，包括决策障碍 - 制作，冲动行为和自我伤害。 PI的飞行员数据表明​​，DBT情绪调节技能可能 对BPD中的情绪目标具有独特的影响，以及超出情绪症状的更广泛影响。 相反，DBT人际关系有效性可能会影响人际目标。但是这个小样本飞行员仍然存在 实验测试不同DBT技能模块的影响的唯一研究。 因此，拟议的研究检查了两个不同的DBT技能培训模块的独特效果。 参与者将是成年人，有BPD和最近的经常性自我伤害行为（n = 81） 分配给六周的DBT情绪调节技能培训（DBT-ER），DBT人际关系有效性技能 培训（DBT-IE）或非技能对照组。使用创新的实验室评估方法， 拟议的研究将研究这些条件对情绪反应和人际关系的影响 功能以及与BPD相关的结果。 AIM 1检查了DBT-ER和DBT-IE的独特效果 它们各自的情感相关（主观和生物学情感反应性，行为情绪调节， 与对照相比，技能使用）和人际（主观和行为）目标。 AIM 2检查 DBT-ER目标参与是否可以预测BPD症状和自我伤害的减少。 AIM 3检查 基线高情绪失调是否预测对DBT-ER条件的反应更大 状况。 研究小组（PI：Dixon-Gordon，Co-I：Gratz；顾问：Cooney，Hazlett；合作者： 君士坦丁字，法律）在DBT，情绪调节，压力的生物学评估方面具有丰富的经验 反应性和治疗研究，因此可以独特地解决这些目标。 拟议的研究对DBT组件对DBT成分的影响的实验检查具有创新性 BPD中的特定目标。鉴于BPD的社会成本很高，这项工作具有重要的公共卫生意义。 调查结果将告知R01提交，检查DBT组件的模块化使用以导致Briefer等等 有效的患者个性化治疗。