Five Year Dialectical Behavioral Therapy Follow Up With Borderline Personality Disorder - Research Proposal Example

? Research Proposal Five Year Dialectical Behavioral Therapy Follow Up With Borderline Personality Disorder The research proposal broad objective will be to prove the effectiveness of a five-year dialectical therapy follow up with Borderline Personality Disorder. A growing number of people in the United States have notably been diagnosed with BPD. This raises deep concerns regarding appropriate therapies that will be effective and affordable to the public. In collecting the relevant information, various peer-reviewed sources will be used. Moreover, a considerable proportion of the patients themselves will also be interviewed as well as their families, relatives, or the people with whom the patients interact with on a daily basis. Primarily, a questionnaire will be used to collect this information. In addition, these questionnaires will also be distributed to medical practitioners in mental health. Various propositions are attested to the current therapies used to treat BPD in the U.S. However, Dialectical Behavior Therapy, DBT, is a type of psychological therapy that is gaining widespread acceptance for treating BPD. Research shows that DBT is effective in the treatment of patients with varied behaviors and symptoms associated with a wide scope of mood disorders. This includes injury to the self, drug dependency, and suicidal attempts. Nonetheless, neither process is effective by itself. Individual therapy is considered effective in controlling suicidal attempts as well as uncontrolled emotional outbreaks especially from disruptive group sessions. On the other hand, the group therapies teach the skills that are exceptional to DBT as well as providing ways of controlling behavior and emotions in a social context. The research proposal will endeavor to ascertain some of the aforementioned findings in order for subsequent further evaluation and determination of the time required to treat BPD wholly. Introduction In the U.S, as time progresses, the number of people diagnosed with BPD continues to increase. This presents mental health specialists with a significant problem since they aim at alleviating mental disorders within the population. In fact, critics argue that such an increase attributes to the specialists’ lack of sufficient knowledge or expertise in their kind of work. Lynch (2003), states that such claims can only be alleviated by the formulation of an effective therapy against the mental disorder. DBT was formulated at the University of Washington by Marsha Linehan, Ph.D. It is a comprehensive treatment for cognitive-behavioral disorders that was initially developed solely for treating chronically suicidal victims suffering from BPS (Miller, 2000). As a result, DBT proves valuable for suicidal behaviors as well as other multiply occurring and severe dysfunctional personality disorders. In the late twentieth century, Marsha Linehan had encountered three particularly troublesome problems with Cognitive Behavior Therapy (Follette, 2006). First, patients receiving CBT perceived the focus on change as useless. They responded by becoming angry and subsequently dropping out. Second, patients seemed to control their therapists, particularly in terms on the topic under discussion. Hence, therapists conducted ineffective treatment, as they seemed to shy away from primary BPD symptoms such as emotional withdrawal or anger inherent in the patients. Thirdly, the severity and massive volume of the patients made it impossible for the treatment to be effective under the standard therapy format. Hence, DBT was formulated as a development of CBT. It included new types of strategies and reformulation of the format of treatment therapy. The problem is why DBT is only effective at reducing psychiatric hospitalization, substance abuse, interpersonal difficulties, anger, treatment dropout, and suicidal behavior. Hence, this proposal aims at persuading mental health specialists that a five-year DBT therapy is effective at eliminating these issues instead of just reducing them. The hypothesis is that the term ‘reducing them’ shows that there is potential of the problems recurring and persisting within the society. Literature review DBT is the first psychotherapy proved to effective in BPD treatment in controlled clinical trials. Even though there are other therapies, DBT gains credibility from its large evidence base in terms of documented success (NIMH, 2013). For instance, two randomized controlled studies have indicated that DBT is more effective, in the treatment of BPD, than Treatment-As-Usual therapies (McMain et al, 2001). When compared to the latter, patients receiving DBT were significantly less likely to commit parasuicidal attempts or drop out of therapy sessions. They reported considerably lesser parasuicidal behaviors will less severe consequences. Moreover, they had a lesser likelihood of hospitalization with subsequent higher scores in social adjustment (Koons et al, 2001). According to Bender et al (2001), DBT bases its therapies on the fact that the core issue in BPD emotional dysfunction that results from genetic factors as well as a childhood environment that was emotionally unstable. It explores contradictory emotions, behavior patterns, and cognitions in an attempt to find middle ground (Bohus, 2000). In other words, its focus is on helping the patient learn and acquire skills that will minimize emotional dysfunctions and unhealthy attempts for coping with strong emotions. DBT therapists use dialectics in two ways. First, they attempt to maintain a collaborative therapeutic relationship with the patient by balancing emotional flexibility and stability in collaboration with change and acceptance. Second, they teach dialectical thinking and behavior by highlighting contradictions in patients’ behavior and thinking, by offering alternative solutions, and by maintaining that truth us not absolute instead, it is constructed and evolves over time. Bateman et al (2001), claims that DBT is similar to Behavior Modification Therapy in that it identifies behavioral excesses and deficits. In his perception, DBT aims at decreasing certain behaviors while motivating others. For instance, in emotional vulnerability versus self-invalidation, DBT aims at increasing emotional modulation and self-validation while decreasing emotional reactivity and self-invalidation. Methodology The research population is generally a large number of more than twenty-five thousand patients who are the focus of the study. It is for their benefit that this research is done. However, due to their large size, we cannot test every individual in the population, as it is too expensive and time-consuming. In this case, five thousand questionnaires will be distributed among BPD patients, mental health specialists, and the people who interact with the patients on a daily basis. Consequently, these questionnaires will be redistributed after every six months as a way of monitoring progress and relevance of the study. This will a non-interventional cross-sectional descriptive study design because the information acquired will be collected directly from the respondents. The cross-section design is because the data will encompass respondents of different genders. On the other hand, the descriptive aspect will entail looking at a respondent’s medical background for BPD patients who have underwent DBT therapy in the past twelve months. We estimate that this follow-up will go on for five years. In addition, BPD patients will have to commit to 12 months of training in psychoeducation skills with subsequent 6-month periods of monitoring. The module will focus on behavioral skills in four areas; mindfulness skills, distress tolerance skills, interpersonal effectiveness skills, and emotion-regulation skills. Each patient will have an individual therapist throughout the five-year study. Other DBT therapists will provide weekly supervision to other DBT therapists where generalization will be promoted by telephone or in vivo sessions. Moreover, they will also supervise the environment structure of the BPD patients via family, school, and other consultations. On the other hand, the patients will use diary cards as a form of self-monitoring. Results This module will be significant in reducing life-threatening homicidal, suicidal, or parasuicidal behaviors. It will also decrease noncompliance and premature dropouts in the therapy sessions. On the other hand, it will increase behavioral skills when coping with emotional-peak instances. Therapists will use functional analysis to identify S-O-R sequences regarding specific instances regarding a patient’s progress. S represents the stimuli that sets the occasion for a certain behavior, O represents the organism while R represents the response observed. Discussion According to Koerner (2007), the adult brain forgets normal behavior permanently after a period of recurrent practice of over four years. Hence, a five-year therapy is suitable to full treatment of patients suffering from DBT. This will improve the patient’s motivation towards a better life and better social skills. Moreover, mental health specialists will enjoy lesser criticism regarding their credibility and expertise. Finally, the society will be more peaceful and life-threatening cases that will result from emotional outbreaks will be significantly reduced. References Bateman A & Fonagy, P. (2001). Treatment of borderline personality disorder with pshychoanalytically-oriented partial hospitalization: an 18-month follow-up. AmericanJournal of Psychiatry, 158, 36-42 Bender D. S., Dolan R. T., Skidol A. E., et al. (2001). Treatment utilization by clients with personality disorders. American Journal of Psychiatry, 158, 295-302 Bohus M., Haaf B. S, & Linehan M. M. (2000). Evaluation of inpatient dialectical behavioral therapy for borderline personality disorder: A prospective study. Behaviour Research and Therapy, 38(9), 875-887 Follette V. M., Ruzek J. L. (2006). Cognitive-behavioral therapies for trauma (2nd ed.). New York: Guilford Press. Koerner, K & Dimeff L. A. (2007). Overview of Dialectical Behavior Therapy, retrieved from, < http://www.ticllc.org/uploads/Clinical_Practice_-_sample_chapter.pdf> accessed April 21, 2013 Koons C. R., Lynch T. R., & Robins C. J. (2001). Efficacy of Dialectical Behavior Therapy in women veterans with Borderline Personality Disorder. Behavour Therapy, 32, 371-390, retrieved from < http://behavioraltech.org/resources/whatisdbt.cfm> accessed April 21, 2013 Lynch T. R., Morse J. Q. (2003). Dialectical behavior therapy for depressed older adults: A randomized pilot study. American Journal of Geriatric Psychiatry, 11(1), 33-45 McMain, S & Korman, L. M. (2001). Dialectical Behavior Therapy and the Treatment of Emotion Dysregulation, retrieved from, < http://courses.washington.edu/dbt560/McMain.pdf> accessed April 21, 2013 Miller, A. L., & Rathus, J. H. (2000). Dialectical Behavior Therapy: adaptations and new applications in cognitive and behavioral practice, retrieved from, accessed April 21, 2013 National Institute of Mental Health (NIMH). (2013). Borderline Personality Disorder, retrieved from, < http://www.nimh.nih.gov/health/publications/borderline-personality-disorder/what-is-borderline-personality-disorder.pdf> accessed April 21, 2013 Read More