DIALECTICAL BEHAVIOR THERAPY DBT APPLIED TO COLLEGE STUDENTS

DIALECTICAL BEHAVIOR THERAPY (DBT) APPLIED TO COLLEGE STUDENTS: A RANDOMIZED CLINICAL TRIAL JACQUELINE PISTORELLO, ALAN E. FRUZZETTI, CHELSEA MACLANE, ROBERT GALLOP, & KATHERINE M. IVERSON Discussed by Kate Theall, Mollee Reitz, and Ali Turner

INTRODUCTION Suicide is a leading cause of death among college students 1/3 of college students report depression so severe it causes dysfunction Approx. 15% of Psychology 101 students screen positive for sig. BPD features DBT is empirically supported for treatment of BPD, depression, suicidal ideation & NSSI DBT -> long-term gains for suicide and other psych. symptom reduction “DBT focuses on teaching skills that are developmentally relevant to college students” DBT is brief, making it an accessible mode of treatment for college students

AIMS OF THE STUDY No previous treatment outcome studies on DBT and college students How does DBT compare to optimized treatment-asusual (O-TAU) for college students with ≥ 3 BPD criteria, current suicidal ideation & history of ≥ 1 NSSI and/or suicide attempt ? How do students’ “baseline levels of global functioning” moderate treatment effects?

PARTICIPANTS AND MEASURES N= 63 college students ages 18 -25 seeking CCC services in Western U. S University that fit the following criteria: suicidal ideation at baseline, had >1 lifetime NSSI/suicide attempt, >3 BPD criteria in Structured Clinical Interview. Randomly assigned treatment conditions, either DBT or O-TAU. Completed assessments every 3 months during treatment period, and once at follow-up. Offered 12 months of therapy, considered “completers” if they did 7 -12 months.

TREATMENT AND DESIGN DBT: (a) weekly 50 -min. individual psychotherapy, (b) weekly 90 min. skills training, (c) skills coaching as needed (via telephone, e-mail, etc. ), (d) weekly 90 -min supervision for therapists, & (e) as-needed family interventions. Optimized treatment as usual (O-TAU): (a) once-weekly 50 -min individual therapy, (b) once-weekly 90 -min group therapy (approx. 8), (c) weekly 90 -min supervision for therapists, (d) asneeded between-sessions, & (e) as-needed family intervention. 5 DBT and 4 O-TAU therapists, Masters level+. 30 hrs training in approach

RESULTS -There were no significant differences found between the DBT group and O-TAU group during pretreatment tests. - There were no significant differences in the number of individual sessions attended by members of each group. However, due to the nature of DBT, members of the DBT group attended significantly more group sessions during treatment than the O-TAU group. -At the posttest, students in the DBT treatment showed decreased suicidality and suicide ideation and were rated significantly less likely to contemplate, attempt, and/or commit suicide. This remained true at the follow-up.

RESULTS -During treatment, there were no significant differences in depression scores until after six months. At six months, DBT emerged as significantly more helpful than O-TAU. DBT showed a significantly higher decrease in depression levels which were still present at follow-up. - Not all students reported NSSIs. However, there was a significant reduction in the mean NSSI report at the end of treatment and follow-up in the DBT group when compared to the O-TAU group. -There was a significantly greater reduction in “borderline criteria” for DBT when compared to OTAU at the posttest, however, there was no significant different at the follow-up.

RESULTS -The SAS-SR was analyzed using HLM and revealed that students in the DBT group showed greater social adjustment than those in the O-TAU group. -DBT students showed a significantly greater reduction in psychotropic medication use than O-TAU students at the end of treatment. *It is important to note that although the DBT procedures were very standardized for this experiment, the O-TAU procedures were not monitored as closely. This could have influenced the results.

DISCUSSION QUESTIONS - Would you consider using DBT with future clients? Why or why not? - What are some drawbacks of using DBT? What appeals to you? - What other disorders might DBT be a good fit for? - What other populations (besides college students) might DBT work with?

REFERENCES Pistorello, J. , Fruzzetti, A. E. , Mac. Lane, C. , Gallop, R. , & Iverson, K. M. (2012). Dialectical behavior therapy (DBT) applied to college students: A randomized clinical trial. Journal of Consulting and Clinical Psychology (80)6, 982 -994.