Behavioral Assessment in DBT: Commentary on the Special Series

Behavioral assessment is woven into the fabric of DBT. The articles of this special series beautifully illustrate this point by describing the relevance and application of behavioral assessment principles in several DBT contexts: creating a case formulation; assessing suicidal behavior; client use of DBT skills; and within family or couple interventions. This commentary highlights themes common to the papers and discusses assessment as it relates to several core concepts in DBT: behaviorism, acceptance, dialectics, and the assumptions about treatment. We identify several dialectical tensions that practitioners must balance when using behavioral assessment strategies. Suggestions for clinical practice are provided.     

Behavioral Assessment in the Schools:

This article discusses behavioral assessment as a way of obtaining and evaluating information used to individualize programming for special needs pupils. Behavioral assessment offers a range of techniques for gathering and for evaluating information. Strategies for obtaining information that are described are self-monitoring, direct observation, permanent product review, and retrospective ratings using behavior checklists. Strategies for evaluating information that are discussed are single-case research designs and social validation. These strategies assist in identifying pupil problems and selecting interventions, evaluating student progress, assessing treatment fidelity, determining causality, and revising individualized programs by providing a broad base for decision-making.     

Behavioral Assessment of Job-Related Skills

An important aspect of finding and retaining employment is a person's level of occupational skills. Little information, however, is currently available on the comparative levels of job-related skills among both unemployed and successfully-employed adults. This study, using direct-observation techniques, analyzes the occupational skills of these two groups. The results show that employed adults performed significantly better than unemployed adults on each of 13 job-related skills assessed. These differences were found for both job-finding and job-retention skills. These assessment methods may be useful to employment counselors interested in helping their clients find and retain satisfactory employment.     

Ecological Momentary Assessment Research in Behavioral medicine

Behavioral medicine research often seeks to examine relatively complex theoretical models and clinical processes. Traditional designs, based on retrospective self-report in the natural environment or laboratory-based studies, cannot assess complex and temporally dynamic psychological, behavioral, and physiological processes in the natural environment. An alternate research approach, Ecological Momentary Assessment (EMA), provides a method to collect such data. This research approach and these data allow investigation of a number of research questions not amenable to other data collection methods. Examples of research questions uniquely suited for EMA data include, but are not limited to: (1) the comparison of retrospective data to momentary data; (2) evaluation of physiological and psychosocial processes in the natural environment; (3) the relation of symptoms and other disease processes to characteristics of the natural environment; and (4) examination of dynamic changes in psychosocial variables that may mediate improvement following treatment. Despite the strengths of EMA data, a number of challenges exist – including logistic, analytic, and interpretation problems – to the easy implementation of EMA approaches in behavioral medicine.     

What You Should Know About Behavioral Assessment

The article provides the reader with an introduction to behavioral assessment. The assumptions and methods of behavioral assessment are described and are then compared and contrasted with those of traditional assessment. Recent developments in behavioral assessments are reviewed. Two case examples illustrate many of the principles and methods of behavioral assessment that are discussed.     

Telehealth for Dialectical Behavioral Therapy: A Commentary on the Experience of a Rapid Transition to Virtual Delivery of DBT

Telehealth has been rapidly adopted to provide continuity of delivery of mental health services in light of COVID-19. However, the remote implementation of intensive treatments like dialectical behavioral therapy (DBT) has been vastly understudied. The aim of the current commentary is to describe potential obstacles, propose solutions, and discuss advantages of transitioning from traditional in-person to a virtual delivery format for full model DBT. We speak to these points at multiple levels of relevance to clinical scientists and practitioners: (1) considerations about the virtual delivery format, (2) considerations for the virtual delivery of DBT specifically, and (3) person-level considerations (e.g., client, clinician). We illustrate the commentary using examples of obstacles encountered and solutions identified during our DBT team’s rapid transition to telehealth in response to COVID-19-related shut-downs and discuss considerations for the extension of telehealth delivery of DBT going forward. We are hopeful that the rapid transition to telehealth delivery of mental health services in response to COVID-19 serves as a call to action for clinicians to adapt and leverage technology to deliver DBT on a broader scale to improve patient health outcomes.     

Behavioral Risk Assessment of the Guarded Suicidal Patient

Psychiatrists and other mental health professionals are trained to assess patients by direct observation and examination. Short inpatient length of stay, brief outpatient visits, emergency room evaluations, and other time‐limited clinical settings require rapid assessment of suicide risk. Recognition of behavioral suicide risk factors can assist in the early identification of the guarded suicidal patient, thus avoiding total reliance on the patient's reporting.     

Clinical Guidelines for Improving Dialectical Thinking in DBT

Cognitive dysregulation, often characterized by extreme, nondialectical thinking, is a core problem area identified in dialectical behavior therapy (DBT) and is posited to contribute to pervasive emotional and behavioral dysregulation. However, cognitive flexibility is understudied and rarely considered a direct treatment target in DBT. This paper provides clinical guidelines for increasing dialectical thinking with patients in DBT. We review the historical context of dialectical thinking in DBT and present the results of a survey examining DBT therapists’ perspectives on nondialectical thinking as a treatment focus. We describe cognitive restructuring strategies from cognitive therapy models, and compare these with techniques targeting cognitive dysregulation in DBT. We highlight the rationale for incorporating dialectical thinking as a direct treatment focus in DBT, and offer strategies derived from cognitive restructuring to incorporate directly targeting dialectical thinking in conceptualization, treatment planning, and in session. These strategies are demonstrated with clinical vignettes and examples.     

The Brazelton Neonatal Behavioral Assessment Scale (BNBAS)

Summary The Brazelton Neonatal Behavioral Assessment attempts to capture the behaviors of the neonate as he defends himself from intrusive, negative stimuli, and controls interfering motor and autonomic responses in order to attend to important social and nonsocial stimuli. In order to conceptualize the 26 behavioral items and 20 reflex scores, four clusters or typologies have been identified which help to reduce the data for analytic purposes with small numbers of subjects. So far few long-term validation studies have been completed, although the scale is in use in many different areas, such as obstetrical medication, predicting to neurological deficits, cross-cultural differences, and with low birth weight infants.This work was supported by grant # 7634-4 of the Grant Foundation, New York.This material appears in expanded form in Osofsky, J. (ed.),Handbook on Infancy, Wiley Interscience, 1977, in press.     

Assessment of Behavioral and Emotional Problems in Infancy: A Systematic Review

Behavioral and emotional problems are highly prevalent in early childhood and represent an important focus of practice for clinical child and pediatric psychologists. Although psychological or psychiatric disorders are not typically diagnosed in children under the age of 2 years, recent research has demonstrated the appropriateness of assessing behavioral and emotional problems during the first 2 years of life (defined throughout as “infancy”). The current paper provides a systematic review of assessment procedures used to identify behavioral and emotional problems during infancy. Existing assessment procedures for infants take the form of parent- or caregiver-report questionnaires, observational coding procedures, and diagnostic classification systems. The questionnaires and observational coding procedures both had substantial psychometric evidence for use with infants, although observational coding may have limited utility in clinical practice. The classification systems have less empirical support for use with infants, and further research is necessary to demonstrate the appropriateness of these procedures with infants. Utilizing the reviewed procedures to assess behavioral and emotional problems in infants can have a substantial impact in research and practice settings, and further research is needed to determine the usefulness of these procedures in developing, testing, and implementing preventive and early intervention programs for infants and their families.     

Toward the Nonpathological Assessment of Behavioral and Conduct Disordered Adolescents

The purpose of this study was to investigate the behavioral problems of 113 adjudicated male juvenile offenders from the normalized, circumplex personality assessment perspective used in the Personal Styles Inventory. The results of the investigation suggest that this assessment model provides correctional practitioners a valid assessment, which is easily understood, sensitive to the needs of both the youth and their families, and useful in developing the goals required of student individual service plans. The findings are discussed in relation to other classification models, as well as their implications for public and residential care treatment programs.     

Brazelton Neonatal Behavioral Assessment Scale: A psychometric study in a Portuguese sample

BackgroundThe Neonatal Behavioral Assessment Scale (NBAS, Brazelton &; Nugent, 1995) is an instrument conceived to observe the neonatal neurobehavior. Data analysis is usually performed by organizing items into groups. The most widely used data reduction for the NBAS was developed by Lester, Als, and Brazelton (1982).ObjectiveExamine the psychometric properties of the NBAS items in a sample of 213 Portuguese infants.MethodThe NBAS was performed in the first week of infant life (3 days ± 2) and in the seventh week of life (52 days ± 5).ResultsPrincipal component analyses yielded a solution of four components explaining 55.13% of total variance. Construct validity was supported by better neurobehavioral performance of 7-week-old infants compared with 1-week-old infants.ConclusionChanges in the NBAS structure for the Portuguese sample are suggested compared to Lester factors in order to reach better internal consistency of the scale.     

An International Assessment of the Emotional and Behavioral Strengths of Youth

The assessment of emotional and behavioral strengths has been identified as an important part of the assessment process for children referred for specialized services. The Behavioral and Emotional Rating Scale-2 (BERS-2; Epstein, Behavioral and Emotional Rating Scale: a strength-based approach to assessment. PRO-Ed, Austin, TX, 2004) was developed as a standardized, norm-referenced instrument to measure strengths of children and youth, and has been found to be a psychometrically sound instrument. We determined the psychometric characteristics of the BERS-2 with a Finnish sample. The BERS-2 was translated in Finnish and 608 Finnish 9th graders filled in the self-evaluation. Results showed that the five subscales of BERS-2 have good reliability and formed a strong strength index. In general, females scored higher than males and special education students scored lower than non-special education students. This study suggests that the translated version of BERS-2 is a valid and reliable instrument in Finland.