DBT-informed treatment in a partial hospital and intensive outpatient program: the role of step-down care

Abstract

Few studies to date have examined Partial Hospital (PH) and Intensive Outpatient (IOP) programs that utilize a Dialectical Behavior Therapy (DBT)-informed model. Preliminary findings suggest that DBT-informed PH programs are effective in reducing clinical symptoms; however, less is known about IOP programs as well as step-down care models. The present study utilized clinically relevant outcome indices and included a heterogeneous clinical sample. Specifically, the present study assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in DBT-informed PH and IOP programs as well as a step-down condition (PH to IOP). Participants included 205 adults (ages M = 35.28, SD = 12.49). The sample was predominantly female (N = 139, 67.8%) and Caucasian (N = 181, 88.3%). The sample was divided into three distinct groups: PH program patients, PH to IOP program step-down patients, and IOP patients. Findings indicated significant symptom reduction from intake to discharge for all three conditions. There were no significant differences in mean change scores in symptom reduction between the three groups. Severity of depression symptoms at intake predicted program placement. However, type of program did not predict significant changes in symptoms from intake to discharge. This DBT-informed PH and IOP program was successful at reducing various psychiatric symptoms in the sample. Clinicians might consider the advantages of placing patients with higher symptoms of depression into PH programs with the intention of transitioning to step-down care through IOP programs that utilize DBT.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Antonsen, B. T., Klungsøyr, O., Kamps, A., Hummelen, B., Johansen, M. S., Pedersen, G., … Wilberg, T. (2014). Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC Psychiatry, 14. https://doi.org/10.1186/1471-244X-14-119. DOI: https://doi.org/10.1186/1471-244X-14-119

Beck, A. T., & Steer, R. A. (1988). BHS, Beck Hopelessness Scale: Manual. San Antonio, TX: Psychological corporation.

Ben-Porath, D. D., & Koons, C. R. (2005). Telephone coaching in dialectical behavior therapy: A decision-tree model for managing inter-session contact with clients. Cognitive and Behavioral Practice, 12(4), 448-460. DOI: https://doi.org/10.1016/S1077-7229(05)80072-0

Bouvard, M., Charles, S., Guerin, J., Aimard, G., & Cottraux, J. (1992). Study of Beck's hopelessness scale. Validation and factor analysis. L'Encephale, 18(3), 237-240.

Chapman, A. (2019). Borderline personality disorder and emotion dysregulation. Development & Psychopathology, 31(3), 1143-1156. doi:10.1017/S0954579419000658. DOI: https://doi.org/10.1017/S0954579419000658

Chapman, A. (2019). Phone Coaching in Dialectical Behavior Therapy. New York: Guilford Press.

Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017). Dialectical behavior therapy group skills training for bipolar disorder. Behavior Therapy, 48(4), 557–566. https://doi-org.jproxy.lib.ecu.edu/10.1016/j.beth.2016.12.006.

Federici, A., & Wisniewski, L. (2013). An intensive DBT program for patients with multidiagnostic eating disorder presentations: A case series analysis. International Journal of Eating Disorders, 46(4), 322–331. https://doi org.jproxy.lib.ecu.edu/10.1002/eat.22112.

Harned, M. S., Chapman, A. L., Dexter-Mazza, E. T., Murray, A., Comtois, K. A., & Linehan, M. M. (2008). Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. Journal of Consulting and Clinical Psychology, 76(6), 1068–1075. https://doi-org.liblink.uncw.edu/10.1037/a0014044.

Harned, M. S., Wilks, C. R., Schmidt, S. C., & Coyle, T. N. (2018). Improving functional outcomes in women with borderline personality disorder and PTSD by changing PTSD severity and post-traumatic cognitions. Behavior Research and Therapy, 103, 53–61. https://doi-org.jproxy.lib.ecu.edu/10.1016/j.brat.2018.02.002.

Jeon, S. W., Han, C., Ko, Y.-H., Yoon, S., Pae, C.-U., Choi, J., Zimmerman, M. (2017). A Korean validation study of the Clinically Useful Anxiety Outcome Scale: Comorbidity and differentiation of anxiety and depressive disorders. PLoS ONE, 12(6). DOI: https://doi.org/10.1371/journal.pone.0179247

Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936. DOI: https://doi.org/10.1037/a0021015

Koerner, K. (2012). Guides to individualized evidence-based treatment. Doing dialectical behavior therapy: A practical guide. New York, NY, US: Guilford Press.

Kröger, C., Harbeck, S., Armbrust, M., & Kliem, S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51(8), 411–416. https://doi. org.jproxy.lib.ecu.edu/10.1016/j.brat.2013.04.008.

Lenz, A. S., & Del Conte, G. (2018). Efficacy of dialectical behavior therapy for adolescents in a partial hospitalization program. Journal of Counseling & Development, 96(1), 15-26. DOI: https://doi.org/10.1002/jcad.12174

Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.

Linehan, M. (2014). DBT Skills Training Manual, Second Edition. New York: Guilford Press.

Linehan, M. M., & Chen, E. Y. (2005). Dialectical behavior therapy for eating disorders. In Encyclopedia of cognitive behavior therapy (pp. 168-171). Springer, Boston, MA. DOI: https://doi.org/10.1007/0-306-48581-8_50

Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97-110. DOI: https://doi.org/10.1176/appi.psychotherapy.2015.69.2.97

Lothes, J. E., Mochrie, K. D., & St. John, J. (2014). The effects of a DBT informed partial hospital program on: depression, anxiety, hopelessness, and degree of suffering. Journal of Psychology and Psychotherapy, 4, 144. doi: 10.4172/2161-0487.1000144. DOI: https://doi.org/10.4172/2161-0487.1000144

Lothes, J. E., Mochrie, K. D., Quickel, E. J. W., & St. John, J. (2016). Evaluation of a Dialectical Behavior Therapy-informed partial hospital program: Outcome data and exploratory analyses. Research in Psychotherapy: Psychopathology, Process and Outcome. 19(2). doi: 10.4081/ripppo.2016.219. DOI: https://doi.org/10.4081/ripppo.2016.219

Maffei, C., Cavicchioli, M., Movalli, M., Cavallaro, R., & Fossati, A. (2018). Dialectical behavior therapy skills training in alcohol dependence treatment: Findings based on an open trial. Substance Use & Misuse, 53(14), 2368–2385. https://doi-org.jproxy.lib.ecu.edu/10.1080/10826084.2018.1480035.000000000.

Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behavior Research and Therapy, 59, 40-51. doi:10.1016/j.brat.2014.05.005. DOI: https://doi.org/10.1016/j.brat.2014.05.005

Neuhaus, E. C. (2006). Fixed values and a flexible partial hospital program model. President and Fellows of Harvard College, 14, 1-14. doi: 10.1080/10673220500519706. DOI: https://doi.org/10.1080/10673220500519706

Öst, LG. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296-321. DOI: https://doi.org/10.1016/j.brat.2007.12.005

Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, 24(2), 213-223. DOI: https://doi.org/10.1177/1049731513503047

Ritschel, L. A., Cheavens, J. S., & Nelson, J. (2012). Dialectical behavior therapy in an intensive outpatient program with a mixed‐diagnostic sample. Journal of Clinical Psychology, 68(3), 221-235. doi:10.1002/jclp.20863. DOI: https://doi.org/10.1002/jclp.20863

Swenson, C. R. (2016). DBT® Principles in Action: Acceptance, Change, and Dialectics. Guilford Publications.

Stoffers, JM, Vollm, BA, Rucker, G., Timmer, A, Huband, N, Lieb, K (2012). Psychological therapies for borderline personality disorder. Cochrane Database Systematic Review, August 15;8:CD005652.

Tarrier, N., Taylor, K., & Gooding, P. (2008). Cognitive-behavioral interventions to reduce suicide behavior a systematic review and meta-analysis. Behavior Modification, 32, 77-108. DOI: https://doi.org/10.1177/0145445507304728

Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061. DOI: https://doi.org/10.1037/0022-006X.69.6.1061

Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015). The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71(1), 1-20. doi:10.1002/jclp.22114. DOI: https://doi.org/10.1002/jclp.22114

West, S. G., & Thoemmes, F. (2010). Campbell’s and Rubin’s perspectives on causal inference. Psychological Methods, 15(1), 18-37. http://dx.doi.org/10.1037/a0015917. DOI: https://doi.org/10.1037/a0015917

Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome scale. Comprehensive Psychiatry, 49(2), 131-140. DOI: https://doi.org/10.1016/j.comppsych.2007.10.006

Zimmerman, M., Chelminski, I., Young, D., & Dalrymple, K. (2010). A clinically useful anxiety outcome scale. Journal of Clinical Psychiatry, 71(5), 534-42. doi: 10.4088/JCP.09m05264blu. DOI: https://doi.org/10.4088/JCP.09m05264blu

Zimmerman, M., & McGlinchey, J.B. (2008) Patient acceptability of the use of scales to monitor the outcome of depression in clinical practice. Annals of Clinical Psychiatry, 20, 125-129. DOI: https://doi.org/10.1080/10401230802177680

Published
2020-09-07
Info
Issue
Section
Articles
Keywords:
DBT-informed Treatment, Partial Hospital, Intensive Outpatient, Step-down Care, Symptom Reduction
Statistics
  • Abstract views: 201

  • PDF: 147
  • HTML: 0
How to Cite
Mochrie, K. D., Lothes II, J., Guendner, E., & St. John, J. (2020). DBT-informed treatment in a partial hospital and intensive outpatient program: the role of step-down care. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(2). https://doi.org/10.4081/ripppo.2020.461