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Results for “Dialectical behavior therapy”

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Cognitive-behavioral treatment of chronically parasuicidal borderline patients.

A randomized clinical trial was conducted to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder. The treatment lasted 1 year, with assessment every 4 months. The control condition was "treatment as usual" in the community. At most assessment points and during the entire year, the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. There were no between-group differences on measures of depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures decreased throughout the year.

Adolescent

Does impulsivity predict treatment outcomes in PTSD with borderline personality disorder features? Results from a randomized clinical trial.

BACKGROUND: Trauma-focused psychotherapies are first-line treatments for posttraumatic stress disorder (PTSD). However, a substantial proportion of clients do not respond adequately or drop out of therapy prematurely. This has sparked interest in identifying individual-level predictors of treatment outcomes, including improvement in PTSD severity and dropout. Impulsivity may be a predictor because it may interfere with key therapeutic processes, such as cognitive restructuring and emotional processing. Consequently, we present a hypothesis-driven secondary analysis of a 15-month randomized clinical trial comparing Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) in women with childhood abuse-related PTSD and borderline personality disorder features to test whether impulsivity, assessed at baseline, predicts PTSD improvement and dropout. We further explore whether the dimensions of impulsivity (non-planning, attentional impulsivity, and motor impulsivity) differentially affect the outcomes in DBT-PTSD vs. CPT. METHODS: A total of 193 cis women with PTSD related to childhood abuse and borderline personality disorder features were assessed using the Clinician-Administered PTSD Scale (CAPS) and the Barratt Impulsiveness Scale (BIS-10). Separate probit models and general linear models were applied to predict dropout and pre-to-post changes in PTSD severity (ΔCAPS) from total impulsivity and subscale scores, i.e. non-planning, attentional and motor impulsivity. RESULTS: Overall, dropout rates were higher for participants with higher baseline impulsivity scores (p = 0.049), particularly for those with higher non-planning impulsivity (p = 0.012). In participants randomized to CPT improvement in PTSD symptom severity (ΔCAPS) was negatively related to baseline total impulsivity (p = 0.021). In participants randomized to DBT-PTSD this relation was not significant. CONCLUSIONS: The results suggest that impulsivity may predict treatment outcomes. Specifically, patients with elevated impulsivity may be less likely to respond adequately to CPT. If replicated, these findings have implications for personalization of treatment.

Humans

The dialectically constituted/decentred subject of psychoanalysis. I. The Freudian subject.

Central among the irreducible elements that define a psychoanalytic understanding of man is Freud's conception of the subject, and yet this theme remained a largely implicit one in Freud's writing. The Freudian conception of the process by which the subject is constituted is fundamentally dialectical in nature and involves the notion that the subject is created and sustained (and at the same time decentred from itself) through the dialectical interplay of consciousness and unconsciousness. The contribution of psychoanalysis to a theory of subjectivity involves the formation of a concept of the subject in which neither consciousness nor unconsciousness holds a privileged position in relation to the other; the two coexist in a mutually creating, preserving and negating relationship to one another. The principle of presence-in-absence and absence-in-presence subtends the dialectical movement between conscious and unconscious dimensions of subjectivity.

Freudian Theory

The process of maintaining hope in adults undergoing bone marrow transplantation for leukemia.

The purpose of this qualitative study was to explore the processes of hoping in adults undergoing bone marrow transplantation (BMT) for leukemia. Grounded theory methodology was used to elicit the experience of hoping in 10 men and 10 women, ages 20-58, who had undergone BMT. The central process described by participants was that of maintaining hope. The core categories used to describe this process were Dealing With It and Keeping It in Its Place. Dealing With It is defined as the process of confronting the negative possibilities inherent in the illness experience and allowing the full range of thoughts, behaviors, and emotions resulting from this confrontation. Keeping It in Its Place is defined as the process of managing the impact of the illness by controlling or limiting one's response to the disease and therapy. The relationship between these two contradictory core categories is explained by The Dialectic of Maintaining Hope. This dialectic is defined as the synthesis of the antithetical strategies of Dealing With It and Keeping It in Its Place in which people are able to transcend each strategy and sustain hope. The findings provide a nascent, explanatory model and information for nurses regarding an important adaptive process.

Acute Disease

"Totem and Taboo" in a latency boy.

Against the background of Freud's "Totem and Taboo" the case of a seven-year-old boy is discusses, focusing on his identification with a cat. Guided by Freud's dialectic thinking and his discussion of the phenomena of patriarchy and matriarchy, one is led to contemplate the totemism of a matriarchally oriented boy. The attempt to understand this child's pathology is based upon the concept of the specificity of a developmental phase. In the light of anthropological data, clinical phenomena are evaluated ontogenetically, in analogy with the recapitulation hypothesis.

Child