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.     

Prefrontal brain activity predicts temporally extended decision-making behavior

Although functional neuroimaging studies of human decision-making processes are increasingly common, most of the research in this area has relied on passive tasks that generate little individual variability. Relatively little attention has been paid to the ability of brain activity to predict overt behavior. Using functional magnetic resonance imaging (fMRI), we investigated the neural mechanisms underlying behavior during a dynamic decision task that required subjects to select smaller, short-term monetary payoffs in order to receive larger, long-term gains. The number of trials over which the longterm gains accrued was manipulated experimentally (2 versus 12). Event-related neural activity in right lateral prefrontal cortex, a region associated with high-level cognitive processing, selectively predicted choice behavior in both conditions, whereas insular cortex responded to fluctuations in amount of reward but did not predict choice behavior. These results demonstrate the utility of a functional neuroimaging approach in behavioral psychology, showing that (a) highly circumscribed brain regions are capable of predicting complex choice behavior, and (b) fMRI has the ability to dissociate the contributions of different neural mechanisms to particular behavioral tasks.     

Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes

This study extends the data on the efficacy of cognitive interventions for patients with chronic medical problems and describes the case of a 37-year-old woman with an anxiety disorder related to diabetes. The effects on panic frequency, use of safety behaviour and related beliefs were investigated after the introduction of two main cognitive-behavioral interventions. The results are consistent with predictions from the cognitive model of panic. This case demonstrates the usefulness of directly challenging the 'meaning' of the feared situation in order to produce clinically significant improvements in the management of physical disease.     

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.     

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Identification With All Humanity: The role of self‐definition and self‐investment

Identification With All Humanity (IWAH) relates to higher levels of concern and supportive behavior toward the disadvantaged, stronger endorsement of human rights, and stronger responses in favor of global harmony. So far, IWAH has been conceptualized as a one‐dimensional construct describing the degree with which one identifies with all humans as a superordinate ingroup. However, recent group identification models suggest a multi‐dimensional model to provide a more differentiated approach toward the understanding of the highest level of social identification. Using principal axis (Study 1) and confirmatory (Study 2) factor analyses, we suggest that IWAH sub‐divides into two dimensions—global self‐definition and global self‐investment. Study 2 revealed that global self‐investment was a stronger predictor for both convergent measures (e.g., social dominance orientation and authoritarianism) and behavioral intentions than global self‐definition. Finally, in Study 3, we manipulated IWAH to test its causal effect on donation behavior. Participants in the experimental condition, compared with the control condition, showed higher global self‐investment, which in turn predicted greater giving to global charity. These findings suggest that two dimensions with different behavioral outcomes underlie IWAH.     

Mother–child affect and emotion socialization processes across the late preschool period: predictions of emerging behaviour problems

The current study examined concurrent and longitudinal relations between maternal negative affective behaviour and child negative emotional expression in preschool age children with (n=96) or without (n=126) an early developmental risk, as well as the predictions of later behaviour problems. Maternal negative affective behaviour, child externalizing emotional expression, and child internalizing emotional expression were observed during a number of lab tasks at child ages 4 and 5, and child externalizing and internalizing behaviour problems were assessed via maternal questionnaire at age 6. Path analyses using structural equation modeling were utilized to test the relations among the variables at ages 4, 5, and 6. A parent‐driven model of emotion socialization emerged, wherein stronger relations were found among maternal negative affect and child externalizing emotions and behaviours than among maternal negative affect and child internalizing emotions and behaviours. Early child risk did not appear to alter the overall emotion socialization process, although higher levels of maternal and child negativity were observed for the children with a developmental risk. Results underscore the complexity of emotion socialization processes throughout the preschool period. Copyright © 2011 John Wiley & Sons, Ltd.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Drop the Small Talk When Establishing Baseline Behaviour in Interviews

The present experiment investigated the behavioural patterns of interviewees when comparing their baseline behaviour, prior to the interview, with their behaviour during the investigative interview. Similar to what has been advised in the police literature, the truthful baseline behaviour was established prior to the interview through non‐threatening questions. The investigative part of the interview then followed in which the interviewee was aware that they would be assessed on whether they were lying. During the investigative part, interviewees either discussed the job that they had (truth tellers, n = 128) or pretended to have (liars, n = 115). Findings revealed that both liars and truth tellers' behavioural patterns differed between the baseline behaviour and the investigative part of the interview. The findings suggest small talk should not be used as a baseline comparison with the investigative part of the interview when determining if the interviewee is being deceitful. An alternative way of using a baseline lie detection method, the comparable truth method, is discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

The relationship between lottery ticket and scratch‐card buying behaviour,personality and other compulsive behaviours

The study examines how demographics, other forms of compulsive behaviour and personality are related to the buying frequency and compulsiveness in lottery tickets and scratch‐cards. An integrative framework is developed and tested in a sample of respondents. Results indicated that the buying compulsivenesses in lottery tickets and scratch‐cards have the same correlates. The buying compulsivenesses in both lottery tickets and scratch‐cards were found to be positively related to cigarette consumption and the extraversion dimension of personality and negatively related to the agreeableness and intellect dimensions of personality. Copyright © 2002 Stewart Publications Ltd.