A Functional Approach to the Assessment and Treatment of Non-Suicidal Self-Injury in Veterans: A Dialectical Behavior Therapy–Informed Perspective

Given that non-suicidal self-injury (NSSI) is related to increased odds of suicidal ideation and suicide attempts, treating NSSI in veterans is a key treatment priority to help reduce suicide risk and increase quality of life. Treating NSSI can be difficult for clinicians and training in addressing NSSI can enhance therapist empathy and decrease negative attitudes. The current paper describes prevalence of and risk factors for NSSI in veterans and presents a Dialectical Behavior Therapy (DBT)-informed approach for arriving at a functional understanding of NSSI in order to inform assessment and treatment. This DBT-informed approach is demonstrated with two case examples of veteran clients. While in many circumstances treatment of NSSI may be most effective in the context of full model DBT (i.e., individual therapy, group skills training, phone coaching, and therapist consultation team), many aspects of the functional approach discussed herein are not specific to DBT and could therefore be integrated into behavioral analyses and case formulations conducted within non-DBT therapeutic approaches.     

MMPI–2 Profiles of Women With Eating Disorders in a Dutch Day Treatment Sample

This study tested two hypotheses concerning productivity and emotional tone as a function of chromatic TAT cards. Two groups of 13 males and 13 females were presented with achromatic and chromatic slides of cards 2, 3BM, 4, 6BM, and 7BM, in counterbalanced order. The main effects of sex membership, order of presentation of stimuli, and color were evaluated. Color did not have a measurable effect. However, a conceptual and aesthetic effect may occur. Males and females differed with respect to emotional tone and response productivity.     

Patients’ Experience of a Narrative Group Therapy Approach Informed by the “Tree of Life” Model for Individuals with Anorexia Nervosa

The aim of this study was to develop and evaluate a pilot group using the Tree of Life model for individuals with a diagnosis of anorexia nervosa. Qualitative feedback from patients was collected in a focus group and analyzed using thematic analysis. Four themes were identified: (1) an image to remember, share, and change, (2) constructing an alternative perspective, (3) hope, and (4) creating a sense of community. The results and their implications are discussed.     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

Randomized Controlled Trial Testing the Effectiveness of a Depression Prevention Program (‘Op Volle Kracht’) Among Adolescent Girls with Elevated Depressive Symptoms

Depression rates rise dramatically from the early to late adolescence. Especially young adolescent girls with elevated depressive symptoms are at high risk for developing a depression during adolescence or adulthood. Therefore, the prevention of depression is important especially in this high-risk group. The aim of the present study was to examine the effectiveness of the Cognitive Behavioral Therapy (CBT) component of the depression prevention program ‘Op Volle Kracht’ (OVK) among Dutch adolescent girls with elevated depressive symptoms. In total, 102 adolescent girls (11–15 years) in the first and second year of secondary school participated in this study. The girls in the experimental group (n?=?50) followed the eight CBT-lessons of OVK and reported depressive symptoms 1 week prior to the start of the lessons, after every lesson, at one-month and 6-months follow-up. The girls in the control group (n?=?52) exclusively reported depressive symptoms at the same time points. Latent Growth Curve Modeling showed that the decrease in depressive symptoms was significantly larger for girls in the experimental group compared to the girls in the control group. Furthermore, it was found that at 6-months follow-up, the girls in the experimental group had significantly lower levels of depressive symptoms compared to the girls in the control group. These findings indicate that the CBT-component of OVK effectively reduces depressive symptoms in short term and possibly prevents the development of a clinical depression.     

Factor Structure of the Center for Epidemiologic Studies–Depression Scale (CES–D) Among Older Men and Women Who Provide Care to Persons with Dementia

The Center for Epidemiologic Studies–Depression Scale (CES–D) is among the most widely used depression screening measures. Existing research suggests a higher order factor structure of responses among older adults (factors labeled as Depressive Affect, Absence of Well-being, Somatic Symptoms, and Interpersonal Affect each loading on a 2nd-order depression factor). This study extended this research to ascertain whether this structure is equivalent (or invariant) between men and women. Findings suggest that the number and relative contribution of each factor is similar for male and female caregivers of persons with dementia. Furthermore, interpretation of CES–D items is statistically indistinguishable for 17 of 20 items across gender within this randomly identified, national sample of respondents. Results of this study support the higher order factor structure of the CES–D and provide data in support of the concurrent validity and reliability of responses within a population at elevated risk for depression.     

Does Adding the Dialectical Behavior Therapy Prolonged Exposure (DBT PE) Protocol for PTSD to DBT Improve Outcomes in Public Mental Health Settings? A Pilot Nonrandomized Effectiveness Trial With Benchmarking

The Dialectical Behavior Therapy Prolonged Exposure (DBT PE) protocol improves DBT’s effects on PTSD in research settings, but its effectiveness in community settings is largely unknown. This pilot nonrandomized controlled trial examined DBT with and without DBT PE in four public mental health agencies. Patients (N = 35, 12-56 years old, 80.0% female, 64.7% racial/ethnic minorities, 44.1% sexual minorities) had PTSD, were receiving DBT, and completed assessments every four months over one year. Sixteen patients (45.7%) initiated DBT PE, 19 (54.3%) did not, and dropout did not differ between groups (31.3% vs. 26.3%). The primary barrier to initiating DBT PE was clinician turnover (57.9% of non-initiators). After adjusting for confounds, DBT PE initiators (g = 1.1) and completers (g = 1.4) showed a greater reduction in PTSD than patients who received DBT only (g = 0.5; p’s < .05). Rates of reliable improvement in PTSD were 71.4% (DBT PE completers), 53.8% (DBT PE initiators), and 31.3% (DBT). Similar patterns were observed for posttraumatic cognitions, emotion dysregulation, general psychological distress, and limited activity days. There was no worsening of self-injurious behavior or crisis service use among patients who received DBT PE. Benchmarking analyses indicated comparable feasibility, acceptability, and safety, but a smaller magnitude of clinical change, than in efficacy studies. Results require replication in a randomized trial but suggest that DBT PE can be transported effectively to community settings.     

Women's Psychological Experiences in a Narrative Therapy-Based Group: An Analysis of Participants' Writings and Beck Depression Inventory–Second Edition

The purpose of this study was to explore women's experiences in a narrative therapy-based group conducted to help participants re-author their stories. Seven women who were either patients or individuals enrolled in Transition Support for Employment at a psychiatric clinic participated in the meetings, one every fortnight. Each session explored a theme based on narrative therapy techniques such as externalization. The participants wrote their reflections during each session, and completed the Beck Depression Inventory-Second Edition (BDI-II) during the initial and final sessions. An affinity diagram was developed to classify their written reflections into 22 lower categories (e.g., new understanding of self, forward-looking-understanding of life) and 4 upper categories (“Insight,” “Sharing with others,” “Changes with understanding of lives,” “Higher motivation”). The relationship among five lower categories comprising “Insight” was explored, and it became apparent that clarification of participants' own thoughts about social problems functioned as a mediator promoting the process. The largest portion of depressed feelings emerged during the initial session, and four participants had lower scores for BDI-II items such as self-criticism in the final session. The results suggest that the group's purpose was realized. However, future studies should examine participants' feelings more closely, especially during the initial session.     

Using Cognitive Processing Therapy–Cognitive in a Residential Treatment Setting With an OIF Veteran With PTSD and a History of Severe Traumatic Brain Injury: A Case Study

The co-occurrence of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) is common among military personnel returning from deployments in Iraq and Afghanistan. Despite the prevalence, scant evidence exists to inform clinicians as how to best treat these individuals, particularly for individuals with PTSD and a history of severe TBI. This case study presents the course of treatment in a VA residential PTSD/TBI program for an Operation Iraqi Freedom Veteran with PTSD, a history of severe TBI, and other psychiatric comorbidities. Cognitive Processing Therapy–Cognitive (CPT-C) was utilized as the primary PTSD treatment in conjunction with ancillary treatment. Data obtained during and following treatment suggest that CPT-C, without modifications to the protocol, offered within a residential treatment program may be an effective treatment for veterans with PTSD and a history of severe TBI.     

Warrior Resilience and Thriving (WRT): Rational Emotive Behavior Therapy (REBT) as a Resiliency and Thriving Foundation to Prepare Warriors and Their Families for Combat Deployment and Posttraumatic Growth in Operation Iraqi Freedom, 2005–2009

Warrior Resilience and Thriving (WRT) and Warrior Family Resilience and Thriving were the U.S. Army’s first combat Soldier and Family cognitive resiliency training classes based on Rational Emotive Behavior Therapy (REBT). WRT, as a pilot program, was designed to enhance soldier and family resiliency, thriving and posttraumatic growth prior to, during and following combat deployments. WRT alloys REBT self-coaching, Army Warrior Ethos, Stoic, survivor and resiliency strategies to teach and promote advanced resiliency, emotional management and critical thinking to soldiers and their families. This article will describe efforts initiated by the author, who served twice in Operation Iraqi Freedom where he developed WRT, as well as training he conducted for over 12,500 Warriors as the Prevention Team Leader for the 98th Combat Stress Control Detachment serving Baghdad. Risk Factors for Army Warriors and families and the advantages of existential and philosophically-based interventions like REBT are described along with a brief inventory of Army resiliency initiatives.