The Handbook of Dialectical Behavior Therapy: Theory, Research, and Evaluation

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The Handbook of Dialectical Behavior Therapy: THEORY, RESEARCH,
AND EVALUATION
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Contents
List of contributors
Preface
I: Overview
1 History and overview of dialectical behavior therapy
	History of dialectical behavior therapy
	Challenges encountered in the development of dialectical behavior therapy
	Overview of the major philosophical aspects of dialectical behavior therapy
		The biosocial theory
		Behavioral and social learning theories
		Acceptance-based philosophies
		The dialectical philosophy
	Dialectical behavior therapy treatment elements
		Treatment modes and targets
			Individual therapy
			Group skills training
			Between-session coaching
			Therapist consultation team
			Ancillary treatment
		Stages of treatment
			Pretreatment
			Stage 1
			Stage 2
			Stage 3
			Stage 4
		Treatment strategies
			Core strategies
				Problem-solving
				Validation
				Dialectics
			Stylistic strategies
			Case management strategies
		Dialectical behavior therapy assumptions
			Assumptions about clients
			Assumptions about therapists and therapy
	Research on dialectical behavior therapy
		Research supporting dialectical behavior therapy for borderline personality disorder
		Research on dialectical behavior therapy with other populations
		Dialectical behavior therapy effectiveness studies
	Summary
	References
	Further reading
2 The therapeutic alliance and therapeutic relationship in dialectical behavior therapy*
	The therapeutic alliance and the therapeutic relationship in dialectical behavior therapy
	The therapeutic alliance: background and overview
	The therapeutic alliance in dialectical behavior therapy
		Therapy through the therapeutic relationship: the alliance and problem-solving in dialectical behavior therapy
		The alliance and problem-solving in dialectical behavior therapy
		Agreement on goals of therapy
			Suicidal behaviors
			Therapy-interfering behavior
			Quality-of-life-interfering behavior and increase in behavioral skills
		Understanding the client
			Suicidal behavior
				Suicidal behavior as “manipulative” or “attention seeking”
			Borderline personality disorder
				Biosocial model of borderline personality disorder
			Dialectical behavior therapy treatment assumptions
			Therapist and team consultation agreements
		Agreements on the tasks of therapy
		Commitment to the goals and task of therapy
	The therapy as the relationship: the therapeutic bond in dialectical behavior therapy
	Research on the therapeutic alliance and relationship in dialectical behavior therapy
	Summary and conclusion
	References
3 Mechanisms of change in dialectical behavior therapy
	Mechanisms of change
	Theory
	Skills and skills training as the key ingredients of dialectical behavior therapy
	Mechanisms related to treatment components: group skills training
		Evidence for skills training as a potential mechanism
	Mechanisms related to changes in the client: increases in skilled behavior
	Increased emotion regulation and mindfulness skills as mechanisms
	Conclusion and future directions
	Acknowledgment
	References
	Further reading
4 Accreditation, adherence, and training in dialectical behavior therapy: data review and practical applications
	DBT training
		Modes of training
	Outcomes for DBT intensive training
		Clinician outcomes
	Client outcomes
	Outcomes for self-study, computer-based, and short instructor–led trainings in DBT
		Community mental health providers
		Graduate student trainees
		Summary of DBT training findings
	Clarifying terminology: adherence, program fidelity, and certification
		Adherence in psychotherapy research
		Adherence and outcomes in DBT
		Program fidelity
	Adherence monitoring in DBT
	A dialectical stance on adherence and training: merits and misunderstandings
		Situational versus dispositional
			Synthesis
		Judgments versus behaviorally specific
			Synthesis
		Proprietary versus pragmatics
			Synthesis
		Practical suggestions for ongoing assessment of adherence and competence
		Options for certification in DBT
	Recommendations and future directions
	References
	Further reading
II: Clinical populations
5 Efficacy of dialectical behavior therapy in the treatment of suicidal behavior
	Treating suicidal behaviors in dialectical behavior therapy
	Suicide crisis behaviors
	Suicide attempts and nonsuicidal self-injury
	Suicidal ideation and communications
	Suicide-related expectancies and beliefs
	Suicide-related affect
	Evidence of dialectical behavior therapy efficacy for suicide-specific outcomes
	Self-directed violence
	Nonsuicidal self-injury
	Attempted suicide
	Psychiatric crisis services
	Suicidal ideation
	Settings and adaptations
	Conclusion
	References
6 Eating disorders
	Review of studies
		Dialectical behavior therapy for eating disorders comorbid with borderline personality disorder
		Dialectical behavior therapy for mixed eating disorder samples
		Dialectical behavior therapy for binge-eating disorder
		Dialectical behavior therapy for bulimia nervosa
		Dialectical behavior therapy for anorexia nervosa
	Conclusion and future directions
		Summary of the research
		Additional considerations and limitations
		Conclusion
	References
7 Dialectical behavior therapy for individuals with substance use problems: theoretical adaptations and empirical evidence
	What is dialectical behavior therapy-substance use disorder
	Randomized controlled trials of dialectical behavior therapy for individuals with substance use problems
		Randomized controlled trials of comprehensive dialectical behavior therapy
			Summary of randomized controlled trials of comprehensive dialectical behavior therapy
		Randomized controlled trials of modified dialectical behavior therapy
			Summary of randomized controlled trials of modified dialectical behavior therapy
		Uncontrolled trials and quasiexperimental trials of dialectical behavior therapy for individuals with substance use problems
		Uncontrolled and quasiexperimental trials of comprehensive dialectical behavior therapy
			Summary of uncontrolled and quasiexperimental trials of comprehensive dialectical behavior therapy
		Uncontrolled and quasiexperimental trials of modified dialectical behavior therapy
			Summary of uncontrolled and quasiexperimental trials of modified dialectical behavior therapy
		Small N pilot studies and case studies involving dialectical behavior therapy for individuals with substance use
	Conclusion
		Limitations and future directions for dialectical behavior therapy with individuals with substance use problems
	References
	Further reading
8 Dialectical behavior therapy for adolescents: a review of the research
	Introduction
	Dialectical behavior therapy
	Dialectical behavior therapy for adolescents
	Empirical support for dialectical behavior therapy for adolescents
	Randomized controlled trials of dialectical behavior therapy for adolescents
		Dialectical behavior therapy with preteens/children
		Nonrandomized studies of dialectical behavior therapy for adolescents
	Future directions and conclusions
	References
9 Clinical illustration of the dialectical behavior therapy for preadolescent children: addressing primary targets
	Treatment targets
	Case illustration
		Child emotional and behavioral difficulties
		Diagnostic impressions
			Primary diagnosis—disruptive mood dysregulation disorder
			Provisional diagnoses—anxiety other specified and attention deficit hyperactivity disorder other type
		Parental emotional and behavioral difficulties
	Treatment structure
	Treatment target hierarchy
	Illustrative transcripts
		Parent training component: evaluation of parental readiness for treatment
	Individual therapy with the child
	Summary
	References
III: Specific settings and populations
10 Research of dialectical behavior therapy in schools
	Introduction
		Mental health disorders among youth in the United States
		Impact of mental health disorders among youth
		Mental health services in schools
		Development of dialectical behavior therapy in schools
	Research examining dialectical behavior therapy in schools
		Feasibility of comprehensive school–based dialectical behavior therapy
		Comprehensive school–based dialectical behavior therapy in schools: Outcomes data
	Staff outcomes related to comprehensive school–based dialectical behavior therapy implementation: reducing burnout
		Universal application of dialectical behavior therapy skills in schools
		Development of dialectical behavior therapy skills in schools: skills training for emotional problem solving for adolescents
		Dialectical behavior therapy skills in schools: skills training for emotional problem solving for adolescents: outcome data
		Future directions
	References
11 Dialectical behavior therapy in college counseling centers
	Introduction
	Comprehensive dialectical behavior therapy in college counseling centers
	Dialectical behavior therapy skills training groups in college counseling centers
		All skills modules
		Specific skills modules
		Summary: dialectical behavior therapy group skills training
		Other dialectical behavior therapy research with college students
	Future directions for dialectical behavior therapy with college students
	References
	Further reading
12 Dialectical behavior therapy research and program evaluation in the Department of Veterans Affairs
	Introduction
	Dialectical behavioral therapy efficacy research in Department of Veterans Affairs
		Efficacy of dialectical behavioral therapy for female veterans with BPD
		Efficacy of dialectical behavioral therapy for veterans at high risk of suicide
	Adaptations of dialectical behavioral therapy skills group
		Dialectical behavioral therapy skills group for transdiagnostic sample
		Dialectical behavioral therapy skills group for depression
		Drop-in dialectical behavioral therapy distress tolerance group
		Affirmative dialectical behavioral therapy skills training for emotion dysregulation and minority stress
	Dialectical behavioral therapy for BPD and PTSD
	Cost of dialectical behavioral therapy
	Evaluation of implementation of DBT in Department of Veterans Affairs
	Future directions for dialectical behavioral therapy research in Department of Veterans Affairs
	Acknowledgments
	References
13 Dialectical behavior therapy stepped care for hospitals
	Stepped care: definition and literature review
	Stepped care applied to dialectical behavior therapy
		Lowest stepped-care level
		Intermediate stepped-care level
		Highest stepped-care level
	Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults (Step2Health)
	Conclusion
	References
14 DBT–ACES in a multicultural community mental health setting: implications for clinical practice
	Dialectical behavior therapy–accepting the challenges of exiting the system
		Diversity in DBT: why focus on diversity in DBT?
	Multiculturalism and treatment
	The dialectic: DBT is culturally competent and may be culturally enhanced
		The DBT consultation team
		What is missing?
	DBT–ACES: state of the evidence
	Multicultural community mental health clinic and barriers to completing DBT–ACES treatment
		Barriers related to cultural dialectics
		Barriers related to intersectionality
	Recommendations for clinical practice
		Multicultural competence of clinicians
		Multicultural models and DBT–ACES
			Derald Sue’s Cross-Cultural Conceptual Framework
			Pam Hay’s ADRESSING Model
		The cultural dialectic and intersectionality
	Summary
	Conclusion
	References
	Further reading
15 A review of the empirical evidence for DBT skills training as a stand-alone intervention
	Method
		Inclusion and exclusion criteria
		Article identification and data extraction
	Results
		Dialectical behavioral therapy implementation
		Treatment outcomes by design
			Single group designs
				Clinical outcomes
				Dialectical behavioral therapy module–related outcomes
			Nonrandomized controlled trials
				Clinical outcomes
				Dialectical behavioral therapy module–related outcomes
			Randomized controlled trials
				Clinical outcomes
				Dialectical behavioral therapy module–related outcomes
		Findings by treatment outcome
			Borderline personality disorder
			Depressive symptoms
			Emotion regulation
			Suicidality or self-injury
			Eating pathology
	Discussion
	References
IV: Future directions
16 Recommendations and future directions for the scientific study of dialectical behavior therapy: emphasizing replication ...
	Threats to the interpretability and coherence of dialectical behavior therapy science
		Replication in science
		Reproducibility in science
		Replication and reproducibility: summary
	Improving dialectical behavior therapy science with an emphasis on replication and reproducibility
		The proliferation of dialectical behavior therapy–based interventions
	Session-rated adherence in dialectical behavior therapy
		Multiple outcomes as a challenge to research synthesis
	Summary and conclusion for the future of dialectical behavior therapy science
	Acknowledgment
	References
Index
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