Dialectical Behavior Therapy: Stage I Treatment for Trauma. COMBAT Conference Kansas City, Missouri Ronda Oswalt Reitz, PhD Missouri Department of Mental Health. Helping people find lives worth living through relentless compassion and effective behavior change strategies.
Kansas City, Missouri
Ronda Oswalt Reitz, PhD
Missouri Department of Mental Health
Helping people find lives worth living through relentless compassion and effective behavior change strategies.
One Year Health Care Costs Per Patient
Estimated for Treatment as Usual (TAU)
Individual Psychotherapy 2,915
Group Psychotherapy 147
Day Treatment 876
Emergency Room Care 56
Psychiatric Inpatient Days 12,008
Medical Inpatient Days 1,094
Behavioral Tech, LLC 2003
Golier et al, 2003 72/108 25%* 13%*
Yen et al, 2002 153/305 51%* 29%
Zanarini et al, 1998 379/125 56%* 22%
Johnson et al., 1999, 2001:
636 youths ages 1-11 and mothers, followed into young adulthood, with Child Protective Services records and self-report assessment of maltreatment
Childhood Physical Abuse, Sexual Abuse, Verbal “Abuse, and Neglect predicted adulthood PBD criteria/diagnosis
Those with abuse or neglect were 4.5 to 7.7 times more likely to have BPD
Trauma is associated with many psychiatric disorders other than BPD—almost all (Paris, 1998)
Only 25% of traumatized children develop adult psychiatric disorders (Werner and Smith, 1992)
Impact of abuse on psychiatric disorders depends on severity; only 25% of patients with BPD report severe trauma (Paris, 1997)
The association of BPD and Sexual Abuse across studies is not very strong (Fossati et al., 1999)
Physical Abuse, Sexual Abuse, and/or Severe Neglect are associated with childhood BPD (Goldman et al., 1992; Guzder et al., 1996) raising question of the direction of association in longitudinal research
Gunderson & Sabo (1993)
BPD creates vulnerability to trauma, which leads to PTSD
Southwick et al. (1993)
Trauma leads to chronic PTSD which contributes to personality adjustment including BPD features
Longitudinal study of adult patients with BPD (n=290) and other PDS (n=72) over 6 years;
BPD was associated with higher rates of verbal, emotional, physical, and sexual abuse
Rates of abuse declined over time
Continued presence of verbal, emotional, and physical abuse predicted non-remission of the BPD diagnosis
Zanarini et al, 2005
Axelrod, Morgan, Southwick, 2005
Looked at Pre- and Post-combat veterans and found that BPD creates a vulnerability to the development of PTSD.
Trauma, particularly in individuals who were younger and who experienced more severe trauma, led to the development of BPD features.
If PTSD symptoms exist prior to trauma, then it increases the probability that an individual will develop BPD symptoms following additional trauma.
When compared to TAU, DBT significantly reduced:
(Linehan, Armstrong, Suarez, Allmon, & Heard, 1991)
Individual Psychotherapy 2,915 3,885
Group Psychotherapy 147 1,514
Day Treatment 876 11
Psychiatric Inpatient Days 12,008 2,614
Medical Inpatient Days 1,094 360
Adds a sixth area of dysregulation in complex trauma:
Somatic or physiological dysregulation
Individuals with significant mood and behavioral dysregulation that would benefit from skill training in any of the following areas:
2. Interpersonal Effectiveness
3. Emotion Regulation
4. Distress Tolerance
Dialectics Helping clients find true balance in “Both…And” emotion, thoughts, and behavior and/or choices. Teaching them, as well as showing them how live in balance.
Validation Acknowledging another person’s reality, “Yes…And” noting that their thoughts, feelings, sensations, and responses are real, and are valid in their own right.
Practice, Practice, Practice
DBT in a Nutshell