Group Therapy Using Dialectical Behavior Therapy
Marsha Linehan developed Dialectical Behavior Therapy (DBT) to provide a therapy modality that would effectively treat individuals suffering from Borderline Personality Disorder (Linehan, 1993). However, DBT has also been designed to help individuals experiencing overwhelming emotionality and severe emotional dysregulation (McKay et al., 2007). This theory of treatment rests upon the biosocial theory of personality development and finds that individuals suffering from Borderline Personality Disorder have a core problem in emotion dysregulation (Linehan, 1993). Linehan (1993) stated, “emotion dysregulation is viewed as a joint outcome of biological disposition, environmental context, and the transaction between the two during development” (p.2).
While DBT was initially developed for the treatment of individuals suffering from Borderline Personality Disorder, it is effective for a wide range of populations (Linehan, 1993). Generally speaking, researchers found that individual treatment would be an effective and less costly option. However, individuals who received only individual treatment as well as individuals who received combined group and individual treatment experienced a reduction in the number of suicide attempts, self-harming behavior, and emergency room visits. While the combined approach was not more effective than individual treatment alone, it is notable that this approach is just as effective. This would indicate that group DBT provides a viable adjunct form of therapy for individuals willing to participate (Andion et al., 2012).
Similarly, Koons et al. (2001) studied women veterans diagnosed with Borderline Personality Disorder. Researchers compared individuals who participated in a traditional DBT form of treatment (i.e. individual and group DBT skills training) to individuals receiving their typical treatment. Results indicated that individuals receiving individual and group DBT demonstrated greater decreases in suicidal ideation, hopelessness, depression, and anger expression (Koons et al., 2001).
Further, only the individuals participating in individual and group DBT experienced significant decreases in the number of parasuicidal behaviors, anger experienced, and dissociation. Finally, the group receiving their typical treatment demonstrated a higher level of medication visits. Researchers attributed this to the lack of group skills training for this treatment group. Specifically, individuals participating in DBT received group skills training which could have provided them with increased emotional regulation and interpersonal skills thus decreasing their medication visits (Koons et al., 2001).
Soler et al. (2009) aimed to compare the effectiveness of DBT-based group skills training to standard group therapy treatment protocols. Researchers found that a lower attrition rate existed for the DBT-based group skills training. Specifically, individuals in the DBT-based group skills training were 30% more likely to complete the treatment. Researchers also found that DBT-based group skills training was superior to standard group therapy in reducing symptoms of depression, anxiety, irritability, anger, and emotional instability. Generally speaking, authors found that DBT-based group skills training provides a relatively straightforward intervention that can be implemented in diverse clinical settings (Soler et al., 2009).
Finally, Gutteling, Montagne, Nijs, and van den Bosch (2012) studied patients diagnosed with Borderline Personality Disorder and the effectiveness of outpatient group DBT. Overall, the group-based approach was effective in reducing psychiatric complaints. Specifically, researchers found that outpatient group-based DBT resulted in a significant reduction in symptoms of depression, suicidal thoughts, anxiety, and anger. In sum, the authors found that outpatient group-based DBT would be an effective option for treating individuals suffering from Borderline Personality Disorder (Gutteling et al., 2012).
In a different area of research, Klein, Skinner, and Hawley (2012) examined the effectiveness of group-based DBT designed to treat individuals suffering from binge eating. The study took place in a community clinic and consisted of women aged 24 to 49. Results indicated significant improvements in participants’ binge eating behaviors as well as secondary outcomes.
Researchers felt that topics such as mindfulness, emotional regulation, and distress tolerance that were covered in the group setting were particularly helpful in improved outcomes. Specifically, these skills were adapted to deal directly with eating-related issues and thus were extremely relevant for participants. It should be noted that this study experienced a particularly high attrition rate. Researchers felt that this was, in part, due to the heterogeneity of the group. Differences in diagnoses and body sizes may have made it difficult for the women to relate to one another (Klein et al., 2012).
Telch, Agras, and Linehan (2001) also focused on women suffering from Binge Eating Disorder in their comparison of group-based DBT to a wait-list control group. Overall, results indicated significant improvements in measures of binge eating as well as measures of pathological eating. Furthermore, the authors found that 89% of participants stopped their binge eating behaviors approximately 4 weeks prior to the end of treatment. While researchers were unclear as to why DBT was effective in treating participants, it is possible that the components of distress tolerance and emotion regulation contributed to participants’ abilities to reduce urges and impulses to eat when experiencing a high level of negative emotions (Telch et al., 2001).
Martin, Chernoff, Buitron, Comulada, Liang, and Wong (2012) studied the effectiveness of DBT, Motivational Interviewing, and other techniques in re-integrating individuals diagnosed with HIV or AIDS into the workforce. Overall, authors found these approaches to be successful in integrating these individuals back into the workforce. Additionally, researchers felt that the interpersonal skills taught in group DBT helped individuals engage in an increased number of job training opportunities (Martin et al., 2012).
Blackford and Love (2011), on the other hand, examined the effectiveness of DBT based group skills training in reducing symptoms and improving the functioning of individuals suffering from severe and persistent mental illness. Results from this study indicated that this therapy modality was associated with improvements for a wide range of diagnoses. Additionally, increased attendance was associated with greater improvement in depressive symptoms, overall symptom improvement, improved quality of life, and improved community functioning. Researchers also found that this modality could be successfully implemented in a community mental health setting with moderately trained clinicians (Blackford & Love, 2011).
Drossel, Fisher, and Mercer (2011) implemented group based DBT with caregivers of individuals suffering from dementia. This study indicated improved psychosocial adjustment, increased problem-focused coping, improved emotional functioning, and decreased fatigue. Results also indicated that these caregivers increased their use of individual therapy services, which could indicate improvement in appropriate help-seeking behaviors. It should be noted that this study experienced a high dropout rate. It is possible that the demands placed on these caregivers made group attendance difficult. Additionally, a small number of participants attended the booster sessions. This could indicate that particularly high-risk participants need continued support (Drossel et al., 2011).
Finally, Sakdalan, Shaw, and Collier (2010) studied the effectiveness of group-based DBT in working with intellectually disabled individuals within a forensic population. Researchers found that this treatment modality decreased risk levels, increased strengths, and improved overall functioning. Researchers also found that group-based DBT could serve as a stand-alone treatment for individuals suffering from similar difficulties (Sakdalan et al., 2010).
DBT is particularly effective in helping individuals regulate overwhelming emotional states (McKay et al., 2007). While it was originally designed for individuals suffering from Borderline Personality Disorder, it does have the ability to be applied to a range of diagnoses (Linehan, 1993). Group-based DBT can stand alone as a treatment modality or serve as an adjunct to round out and complete existing treatment protocols. It also provides benefits such as the ability to treat more than one individual at a time, its effectiveness for a range of diagnoses, and its cost-effectiveness (Andion et al., 2012; Blackford & Love, 2011; Gutteling et al., 2012).
About the Author
Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.
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