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Sara J. Landes1,2, Marsha M. Linehan2, Anthony DuBose3, & Kate Comtois2
1National Center for PTSD, VA Palo Alto Health Care System 2University of Washington 3Behavioral Tech LLC
Suicidal behavior Non suicidal self injury Depression - - PowerPoint PPT Presentation
Suicidal behavior Non suicidal self injury Depression - - PowerPoint PPT Presentation
Sara J. Landes 1,2 , Marsha M. Linehan 2 , Anthony DuBose 3 , & Kate Comtois 2 1 National Center for PTSD, VA Palo Alto Health Care System 2 University of Washington 3 Behavioral Tech LLC Suicidal behavior Non suicidal self
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- Suicidal behavior
- Non‐suicidal self‐injury
- Depression
- Hopelessness
- Anger
- Symptoms of eating disorders
- Substance dependence
- Impulsiveness
- General adjustment
- Social adjustment
- Treatment retention
- Positive self esteem
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System Orientation Study Group Part I Part III Functional Systemic Support Mechanisms Consultation
(Program Development)
Adherence to Treatment Protocols
(Clinical Cases)
Ongoing / Supplemental Training and Consultation as Needed
1. Administrator Training
Implement Program
Introductory Workshop + Consultation with Institutional Leadership Read Manual / Online Training (Organize Teams) 5-Day Treatment Content and Structure Homework / Exercises / Take-Home Exam/ Outcome data collection Online Learning Courses 5-Day Consultation on Program Implementation / Experiential Learning
Part II
3-day Skills training
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Create a team first and go through the manual together
Add modes gradually
- Skills training, individual, phone calls
Adapt to setting
- e.g., no phone calls for coaching in a prison
setting, floor coaching in residential settings
Start small and build
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Participants showed a significant increase in DBT knowledge between all time points
- Part I to Mid‐Intensive (t(38) = 5.81, p<.001)
- Mid‐Intensive to Part II (t(49) = 2.43, p<.02)
- Part I to Part II (t(39) = 6.99, p<.001)
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Standard DBT Treatment Modes Offered at End of Part II, 2000 Offered in Oct, 2001 DBT Group Skills Training 11 (78.6%) 12 (85.7%) DBT Individual Psychotherapy 7 (50.0%) 10 (71.4%) DBT Therapist Consultation Team 10 (71.4%) 10 (71.4%) Telephone Consultation 4 (28.6%) 6 (42.9%) Complete DBT Model without Telephone Consultation 7 (50.0%) 10 (71.4%) Complete DBT Model with Telephone Consultation 4 (28.6%) 6 (42.9%) Optional DBT Treatment Modes Offered at End of Part II, 2000 Offered in Oct, 2001 DBT Individual Skills Training 6 (42.9%) 7 (50.0%) DBT Pharmacotherapy 4 (28.6%) 4 (28.6%) DBT Case Management 3 (21.4%) 3 (21.4%) DBT Support/Process Group Psychotherapy 4 (28.6%) 5 (35.7%) None 1 (7.1%) 1 (7.1%)
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Program adherence measure has been piloted and will be used for program accreditation
Because of the complexity of the in‐session adherence measure, it’s been limited to research
- Haven’t yet found a way to do assess in‐session
adherence that’s easily disseminable
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Review of 25 studies of DBT in the community, primarily trained with intensive training showed improvements in various client outcomes
Outcome data from Part II
- Average number of self‐inflicted injurious acts
▪ 1st month of treatment = 3.67 ▪ Current month of treatment = 0.83 ▪ t(5)=‐1.63, 1‐tailed p‐value=0.08, d=0.66
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In development at the University of Washington
Computed Global Score of DBT adherence and sub‐scale scores for 12 strategy domains
Composed of 66 items reflective of major DBT strategies, each operationalized with behaviorally defined anchor points
Conditions for scoring take into account the necessity and sufficiency of each strategy given the context of the session and prescriptions and proscriptions of the DBT treatment manual
Inter‐rater reliabilities of mean scores in previous samples
- f strategy items range from .78 to .83, with correlations