Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical Illness (DBT-CMI)

Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence.DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.     

怎样看待和认识休克

哲学素质在现代医学实践中具有重要意义,它不仅是医务工作者的思维武器,更是了解医学前沿和解决医学难题的钥匙。本文就以休克这一临床上常见的危急重症为例,探讨休克发生发展过程中的哲学因素,旨在阐明自觉运用马克思主义哲学的思辨观来指导休克的诊疗过程实属必要,对医生及患者都大有益处。     

Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

This study evaluated the effectiveness of dialectical behavior therapy (DBT) for treating eating disorder episodes and co‐occurring depression symptoms among individuals diagnosed with eating disorders. Separate meta‐analytic procedures for between‐groups and single‐group studies were conducted and yielded large effect sizes, indicating that DBT may be efficacious for decreasing disordered episodes among women diagnosed with eating disorders; medium to large effect sizes were noted for treating depression symptoms. Implications for evidence‐supported practice and study limitations are discussed.     

Memory for a dialectical and a nondialectical prose passage in young and older adults

Age differences in adults' processing of a dialectical or nondialectical prose passage were explored. Twenty young and 20 older adults read a dialectical or mechanistic passage and were tested for free recall and recognition after a 30-min delay (filled with vocabulary and paradigm belief scale). Older (vs. young) adults had significantly lower formistic and mechanistic scores and showed greater relative preference for relativistic and dialectical beliefs (paradigm scale). There were no age differences in amount of free recall or number of correct responses (hits) on recognition, but older adults produced more spontaneous dialectical distortions in recall of the mechanistic passage and more paradigm-congruent false alarms on recognition. There was also a move from absolute toward dialectical thinking on the paradigm scale and, among males, on the recognition measure. Dialectical scores (paradigm scale) were positively correlated, and mechanistic scores negatively correlated, with number of dialectical distortions on free recall (mechanistic passage), while dialectical scores were positively correlated with number of dialectical false alarms (dialectical passage).     

Argument Structure and Disciplinary Perspective

Many in the informal logic tradition distinguish convergent from linked argument structure. The pragma-dialectical tradition distinguishes multiple from co-ordinatively compound argumentation. Although these two distinctions may appear to coincide, constituting only a terminological difference, we argue that they are distinct, indeed expressing different disciplinary perspectives on argumentation. From a logical point of view, where the primary evaluative issue concerns sufficient strength of support, the unit of analysis is the individual argument, the particular premises put forward to support a given conclusion. Structure is internal to this unit. From a dialectical point of view, where the focus concerns how well a critical discussion comes to a reasoned conclusion of some disputed question, the argumentation need not constitute a single unit of argument. The unit of dialectical analysis will be the entire argumentation made up of these several arguments. The multiple/co-ordinatively compound distinction is dialectical, while the linked/convergent distinction is logical. Keeping these two pairs of distinctions separate allows us to see certain attempts to characterize convergent versus linked arguments as rather characterizing multiple versus co-ordinatively compound arguments, in particular attempts of Thomas, Nolt, and Yanal, and to resolve straightforwardly conflicts, tensions, or anomalies in their accounts. Walton's preferred Suspension/Insufficient Proof test to identify linked argument structure correctly identifies co-ordinatively compound structure. His objection to using the concept of relevance to explicate the distinction between linked and convergent structure within co-ordinatively compound argumentation can be met through explicating relevance in terms of inference licenses. His counterexample to the Suspension/No Support test for identifying linked structure which this approach supports can itself be straightforwardly dealt with when the test is explicated through inference licenses.     

Standing in the gap: ref lections on translating the Jung‐Neumann correspondence

This paper considers the experience of translating the correspondence between C.G. Jung and Erich Neumann as part of the Philemon series. The translator explores the similarities between analytical work and the task of translation by means of the concepts of the dialectical third and the interactional field. The history and politics of the translation of analytic writing and their consequences for the lingua franca of analysis are discussed. Key themes within the correspondence are outlined, including Jung and Neumann's pre‐war exploration of Judaism and the unconscious, the post‐war difficulties around the publication of Neumann's Depth Psychology and a New Ethic set against the early years of the C.G. Jung Institute in Zurich, and the development of the correspondents’ relationship over time.     

Efficacy of Dialectical Behavior Therapy for Adolescents in a Partial Hospitalization Program

This study evaluated dialectical behavior therapy for adolescents (DBT‐A) vs. treatment as usual within a 6‐week partial hospitalization program. The 103 adolescent participants (mean age = 15.27 years) were predominantly girls (n = 63, 61%) with a variety of primary mental health diagnoses. Results indicated that DBT‐A was superior for decreasing symptoms of depression and interpersonal sensitivity, but no statistically significant difference was detected for anxiety or hostility. Implications for treating youth with transdiagnostic identities 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.