Dialectical behavior therapy: current status, recent developments, and future directions

Dialectical behavior therapy (DBT) was developed as a treatment for parasuicidal women with borderline personality disorder and has been adapted for several other populations. This article describes standard DBT and several adaptations of it and reviews outcome studies with borderline patients in outpatient, inpatient, and crisis intervention settings, borderline patients with substance use disorders, suicidal adolescents, patients with eating disorders, inmates in correctional settings, depressed elders, and adults with attention-deficit/hyperactivity disorder. This treatment outcome review is followed by discussion of predictors of change in DBT, possible mechanisms of change, and current developments in theory, practice, and research.     

Acceptability of interventions for aggressive behavior in long-term care settings: comparing ratings and hierarchical selection

Fifty-six active treatment team members in long-term nursing care facilities completed an online survey assessing treatment acceptability of modern behavioral, pharmacological, and sensory interventions. A traditional treatment acceptability rating scale was compared to treatment selections in a paired-options format. Unlike earlier research, there were no significant differences in acceptability between the 3 interventions on the traditional rating scale. However, ratings and selections were significantly correlated for behavioral and pharmacological interventions. The clinical significance of such relations and the implications for the use of treatment ratings is discussed.     

Suicidal behavior in long-term care facilities

Questionnaires were mailed to a random sample of administrators of 1,080 long-term care facilities, in order to obtain information on the extent and nature of overt suicide and intentional life-threatening behavior (ILTB). Rates were calculated for death for overt suicides and ILTB. In-depth case studies, involving observation, interviews, and examination of medical records, were conducted in four facilities. Quantitative analysis revealed that white males were most at risk. Refusing to eat or drink and refusing medications were the most common suicidal behaviors. Depression, loneliness, feelings of family rejection, and loss were significant factors.     

Vicarious traumatisation: current status and future directions

Theorists and practitioners have long recognised that working with trauma clients can trigger reactions in the therapist similar to those experienced by the client. Nevertheless, research in this area has been lacking. One obstacle has been confusion regarding key terms. Vicarious traumatisation is the most appropriate concept given that it relates specifically to trauma work, incorporates intrinsic and extrinsic factors, and can be located within the framework of the constructivist self-development theory. Although limited, research has identified a range of factors that influence vicarious traumatisation, such as experience, personal trauma history and coping style. Future investigation is required to examine aspects that could enhance counsellor resilience. In addition, vicarious traumatisation needs to be studied in terms of a broad range of clientele and occupations.     

Critical consciousness: current status and future directions

In this chapter, the authors consider Paulo Freire's construct of critical consciousness (CC) and why it deserves more attention in research and discourse on youth political and civic development. His approach to education and similar ideas by other scholars of liberation aims to foster a critical analysis of society--and one's status within it--using egalitarian, empowering, and interactive methods. The aim is social change as well as learning, which makes these ideas especially relevant to the structural injustice faced by marginalized youth. From their review of these ideas, the authors derive three core CC components: critical reflection, political efficacy, and critical action. They highlight promising research related to these constructs and innovative applied work including youth action-research methodology. Their conclusion offers ideas for closing some of the critical gaps in CC theory and research.     

Avoidant personality disorder: current status and future directions

Avoidant Personality Disorder (APD) is the topic of a growing body of research literature. In this article, we review empirical studies of APD with the goals of identifying the themes that underlie this work and pointing to new directions for future research. In particular, we recommend that future studies evaluate several unique factors postulated by personality theorists to be central to this condition.     

Self-help and long-term behavior therapy for obesity

The Trevose Behavior Modification Program, a self-help group offering continuing care for obesity, has recently been shown to produce large long-term weight losses. The present study aimed to replicate this finding across different settings and participants, assessing the weight losses and attrition rates of 128 participants in three Trevose program satellite groups that used the same treatment procedures and manual as the central Trevose group. The satellite groups' results closely paralleled those of the Central Group. Mean intent-to-treat weight loss, or final losses recorded for all participants regardless of their treatment termination date, was 13.7 +/- 0.7% of initial body weight (1.8 +/- 0.7 kg). At two years, 43.8% of participants remained in treatment, having lost a mean of 19.0 +/- 0.8% of their body weight (16.2 +/- 1.0 kg); at five years, 23.4% remained, having lost 18.4 +/- 1.1% of body weight (15.6 +/- 1.5 kg). These results demonstrate that the Trevose model of weight control, combining self-help and continuing care, can be extended and disseminated to other settings, with potentially significant public health consequences.     

Psychotherapy of depression: current status, future directions

This article reviews recent studies of psychotherapy for treatment of depression. There is evidence that cognitive behavioral and interpersonal therapies are useful treatments for depressed outpatients, roughly comparable to antidepressant pharmacotherapy. Pharmacotherapy and psychotherapy do not, however, necessarily treat the same patients and there is emerging evidence of a neurobiological "boundary" that may delimit therapy response. Psychotherapy plus pharmacotherapy combinations appear particularly useful for outpatients with more severe, recurrent depressions. Depression-focused psychotherapy may also provide an important alternative to an indefinite course of maintenance pharmacotherapy for patients at high risk for recurrence.     

On the current status of the evolutionary theory of behavior dynamics

The evolutionary theory of behavior dynamics is a complexity theory that instantiates the Darwinian principles of selection, reproduction, and mutation in a genetic algorithm. The algorithm is used to animate artificial organisms that behave continuously in time and can be placed in any experimental environment. The present paper is an update on the status of the theory. It includes a summary of the evidence supporting the theory, a list of the theory's untested predictions, and a discussion of how the algorithmic operations of the theory may correspond to material reality. Based on the evidence reviewed here, the evolutionary theory appears to be a strong candidate for a comprehensive theory of adaptive behavior.     

Multiple family therapy: current status and critical appraisal

This article provides an updated review and synthesis of the research and clinical literature dealing with multiple family therapy as an identifiable treatment approach. Major emphasis is placed on the literature published since an earlier comprehensive review (63). It is concluded that multiple family therapy is a viable and promising treatment modality, yet one that in clinical practice remains underused, conceptually underdeveloped, and poorly differentiated from other treatment approaches. Recommendations are made and pathways are identified that may promote the further growth and development of the approach.     

Functional analysis and treatment of problem behavior of elderly adults in long-term care

Functional analyses were conducted for the problem behavior of 3 older adults in a long-term care setting. Two of the problem behaviors were maintained by attention, and a third was maintained by escape from demands. Function-based interventions were implemented that resulted in decreases in problem behavior in each case. Implications for the use of functional analysis and function-based interventions in the field of gerontology are discussed.