Computerized Trans-Diagnostic Dialectical Behavior Therapy Skills Training for Emotion Dysregulation
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Over the last several decades, research in clinical psychology has generated many different treatments targeting many different mental disorders. Yet many individuals with mental health problems do not receive evidence based treatments (EBTs) fitting their clinical profile (Kessler, Merikangas, & Wang, 2007; Shafran et al., 2009; Stobie, Taylor, Quigley, Ewing, & Salkovskis, 2007). Two important obstacles to this goal are: (1) the current symptom-based classification system for mental health disorders, and (2) the dearth of cost-effective treatment dissemination mechanisms. Following an increase in understanding psychopathology driven by behavioral studies and cognitive neuroscience, the field has witnessed the emergence of trans-diagnostic treatments targeting general dysfunctional processes and mechanisms of change common across disorders. Large-scale treatment dissemination remains a grand challenge for the field (Biederman, Newcorn, & Sprich, 1991; Regier, Narrow, Kuhl, & Kupter, 2009). Common barriers include the high cost of face-to-face treatment, mental health stigma, and inaccessibility due to geographical locations (Biederman et al., 1991; Conway, Compton, Stinson, & Grant, 2006). Computerized psychotherapy treatments can enable large-scale dissemination of EBTs and several have been found efficacious in depression and anxiety disorders (Cartreine, Ahren, & Locke, 2010; Marks, Cavanagh, & Gega, 2007; Marks, Kenwright, McDonough, Whittaker, & Mataix-Cols, 2004; Proudfoot et al., 2003; D. Richards & Richardson, 2012). This project builds on both a theoretical model proposing emotion dysregulation as a trans-diagnostic mechanism of disorder and on supporting evidence that DBT skills training can be an effective treatment for decreasing emotion dysregulation trans-diagnostically (Neacsiu, 2012; Neacsiu, Eberle, Kramer, Weismann, & Linehan, 2014). This project unfolded in two phases. In Phase 1 of this project we developed and tested feasibility and in Phase 2 we evaluated a computerized trans-diagnostic DBT skills training intervention targeting individuals with difficulties regulating their emotion who met diagnostic criteria for mood and anxiety disorders. Seven men and women who met criteria for at least one mood or anxiety disorder and who reported high emotion dysregulation were included in Phase 1 of the study. They went through the computerized intervention by coming to our research laboratory and then they provided qualitative and quantitative feedback on different components of the intervention and their experience during a post-session interview with a research assistant. Phase 1 participants were assessed before treatment started at the middle of treatment and at the end of treatment. Participants reported reductions in emotion dysregulation, anxiety, depression as well as increases in mindfulness and use of skillful behavior. Phase 1 participants found the intervention acceptable and usable. Qualitative feedback from Phase 1 participants was utilized to modify the intervention by improving its usability and acceptability resulting in the intervention evaluated in Phase 2. Twenty five men and women participated in Phase 2 of the intervention meeting similar inclusion criteria to Phase 1 (reported high emotion dysregulation and met criteria for at least one mood or anxiety disorder). Participants went through the intervention online in their own environment. Participants were assessed before treatment started, at the middle of treatment, at the end of treatment and at two months follow-up. Participants reported reductions in emotion dysregulation, anxiety, depression, general distress as well as increases in mindfulness and use of skillful behavior. Results were compared to findings from a historical control study that recruited a similar clinical population (high in emotion dysregulation and meeting diagnostic criteria for a mood and/or anxiety disorder) and taught DBT skills in a face-to-face format. Findings and future directions are discussed in the context of the current treatment literature. Comparison to historical control study revealed post-treatment effect sizes comparable at a descriptive level with the effect sizes of face-to-face therapy. Future work includes using the iDBT intervention as an add on to individual therapy, expanding the intervention to different clinical groups, expanding the intervention to include all DBT skills, as well as using the intervention within a stepped care model.
- Psychology