Sustained efficacy of dialectical behaviour therapy for borderline personality disorder

Dialectical Behaviour Therapy (DBT) is considered one of the most promising treatments for borderline personality disorder (BPD). Recently, we reported significantly positive effects of 12 months DBT on parasuicidal behaviour and impulsivity in a mixed group of female BPD patients with and without substance abuse. Fifty-eight women with BPD were randomly assigned to either 52 weeks of DBT or treatment as usual (TAU). Follow-up assessment took place at 78 weeks, i.e., 6 months after discontinuation of DBT. Participants were clinical referrals from addiction treatment and psychiatric services. Outcome measures included parasuicidal behaviour, impulsivity and substance abuse. Six months after treatment discontinuation, the benefits of DBT over TAU in terms of lower levels of parasuicidal and impulsive behaviours, and in alcohol use, sustained. No differences between the treatment conditions were found for drug abuse. In conclusion, DBT seems to have a sustained effect on some of the core symptoms of BPD and on alcohol problems in a mixed population of female borderline patients with and without substance abuse problems.     

Sehen, Sichtbarkeit und empirische Forschung

Vision, Visibility, and Empirical Research. In general, natural scientists use the concept of observation in a liberal way: they talk of observing electrons, DNA, or distant quasars. Several philosophers of science have recently argued for a similar use of the concept of observation: they have claimed that the important aspects of scientific research can only be properly reconstructed in accordance with how this term is actually used in science. With reference to an example from astronomy, I point out that the proposed generalisation of the concept of observation leads to undesirable consequences. I argue that a differentiated conceptual framework is required in order to give an adequate account of the varieties of scientific experience. Thus, the appropriate starting point for distinguishing these various scientific research practices should not be the generalised scientific conception of observation, but instead distinctly different uses of the term observation drawn from ordinary language. This revised version was published online in August 2006 with corrections to the Cover Date.     

The gap that makes us desperate: Paths from language to mental health

Although past research provided some clues about the relation of language use with mental health, the mediatory functions of personality variables in this relationship have been ignored. This research examined the mediatory role of self‐concept clarity in the relationship between language use perceived by individuals and mental health indicators including anxiety, depression, and alexithymia. Based on the theoretical framework suggested by ?im?ek (2010), two studies sought to test two alternative structural equation models in data from university students in the first study (n = 250) and data from other groups in the second study (n = 331). The first model assumed that the relationship of language use with anxiety, depression, and alexithymia was mediated by self‐concept clarity. The second model tested the mediatory role of both anxiety and self‐concept clarity in this relationship. The results of the first study showed that the second model fitted better to the data than the first. Consistent with the first study, the results of the second study confirmed that the second model produced better goodness of fit statistics than the first model.     

Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.     

Personality and Substance Use in Midlife: Conscientiousness as a Moderator and the Effects of Trait Change

Personality traits predict substance use in adolescence, but less is known about prospective substance use in middle age and beyond. Moreover, there is growing interest in how personality change and the multiplicative effects among personality traits relate to substance use. Participants included approximately 4000 adults aged 25-74 who participated in two waves of the Midlife in the US (MIDUS) study. Higher levels of neuroticism, extraversion, openness, and lower levels of conscientiousness and agreeableness predicted longitudinal substance use. Increases in neuroticism and openness predicted increased substance use while increases in conscientiousness and agreeableness predicted decreased substance use. Higher levels of conscientiousness moderated two of the other trait main effects. Personality, trait change, and interactions among traits reliably forecasted 10-year substance-use behaviors.     

Do Parent–Adolescent Discrepancies in Family Functioning Increase the Risk of Hispanic Adolescent HIV Risk Behaviors?

In the family‐based prevention science literature, family functioning, defined as positive parenting, parental involvement, family cohesion, family communication, parental monitoring of peers, and parent–adolescent communication, has been shown to ameliorate HIV risk behaviors in Hispanic youth. However, the majority of studies have relied solely on parent or adolescent reports and we know very little about parent–adolescent family functioning discrepancies. Therefore, the purpose of this study was to examine whether and to what extent parent–adolescent discrepancies in family functioning increased the risk of HIV risk behaviors, including substance use and sexual risk behaviors, and whether these associations vary as a function of acculturation and youth gender. A total of 746 Hispanic 8th grade youth and their primary caregivers were included in the study. Structural equation modeling findings indicate that parent–adolescent family functioning discrepancies are associated with an increased risk of Hispanic adolescent HIV risk behaviors, including lifetime and past 90‐day alcohol and illicit drug use, and early sex initiation. In addition, study findings indicate that results vary by acculturation and youth gender. Findings are discussed in the context of existing family‐based research and practice in preventing and reducing HIV risk behaviors among Hispanic youth and their families.     

Indigenizing CBPR: Evaluation of a Community-Based and Participatory Research Process Implementation of the Elluam Tungiinun (Towards Wellness) Program in Alaska

The process that community based participatory research (CBPR) implementation takes in indigenous community contexts has serious implications for health intervention outcomes and sustainability. An evaluation of the Elluam Tungiinun (Towards Wellness) Project aimed to explore the experience of a Yup'ik Alaska Native community engaged within a CBPR process and describe the effects of CBPR process implementation from an indigenous community member perspective. CBPR is acknowledged as an effective strategy for engaging American Indian and Alaska Native communities in research process, but we still know very little about the experience from a local, community member perspective. What are the perceived outcomes of participation in CBPR from a local, community member perspective? Qualitative methods were used to elicit community member perspectives of participation in a CBPR process engaged with one Yup'ik community in southwest Alaska. Results focus on community member perceptions of CBPR implementation, involvement in the process and partnership, ownership of the project with outcomes observed and perceived at the community, family and individual levels, and challenges. A discussion of findings demonstrates how ownership of the intervention arose from a translational and indigenizing process initiated by the community that was supported and enhanced through the implementation of CBPR. Community member perspectives of their participation in the research reveal important process points that stand to contribute meaningfully to implementation science for interventions developed by and for indigenous and other minority and culturally diverse peoples.     

Barriers to Addressing Substance Abuse in Domestic Violence Court

Substance abuse commonly co-occurs with intimate partner violence among both perpetrators and survivors. Specialized courts that focus on intimate partner violence provide a unique opportunity to address both problems simultaneously, but research has yet to identify whether this happens. In this qualitative study of a domestic violence court in a large midwestern metropolitan area, key informants were interviewed to understand how the Court treats substance abuse. Results indicate that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to such identification are the organization of the Court, bounded definition of actors’ roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.     

Blind Intuitions: Modernism's Critique of Idealism

Adorno contends that something of what we think of knowing and rational agency operate in ways that obscure and deform unique, singular presentations by relegating them to survival-driven interests and needs; hence, in accordance with the presumptions of transcendental idealism, we have come to mistake what are, in effect, historically contingent, species-subjective ways of viewing the world for an objective understanding of the world. And further, this interested understanding of the world is deforming in a more radical way than just obscuring what is there for the sake of interested needs and purposes; these instrumental ways of knowing and acting, are broadly self-interested, in the interest of survival, without effective concern for the well-being and worth of others; by becoming generalized and exclusive, hegemonic, by driving out modes of encountering things and persons that support their differences and independence, their needs and interests, these instrumental practices are the deepest cause of the ills of our time. As heightened forms of rational self-interest, self-interest being the drive of reason, transcendental interests suppress the interests of others. Adorno argues that modernist artistic practices perform a critique of the set of assumptions governing idealism by demonstrating how there is a suppressed rational form of human comportment directed towards the making and comprehension of unique sensuous particulars. Art, according to Adorno's ‘Aesthetic Theory’, is a broken off and isolated fragment of human knowing; in its hibernates the rational forms of acting and knowing that have been suppressed in the coming to be of Enlightened modernity.