New approaches in therapy
The studies I address today all illustrate specific approaches to therapy. First, Palmer et al. (2023) published “Words Count in Psychotherapy: Differentiating language characteristics of cognitive behavioral therapy and focal psychodynamic therapy for anorexia nervosa” in Psychotherapy. Here are the edited abstract and impact statements:
It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. CBT therapists speak more in general and emphasize eating and positive emotions. FPT therapists emphasize social processes. The findings can inform future studies comparing these treatment approaches, examining automated adherence control, and working mechanisms of CBT and FPT.
I appreciate creative approaches to research and contrasts between therapeutic approaches. This work may be helpful to clinicians who work with clients with anorexia whose needs may differ. The next two studies look at dialectical behavior therapy and borderline personality disorder (BPD).
Hood, Maraun, McMain, Kuo & Chapman (2023) published “The Role of Mindfulness and Emotion Regulation in Dialectical Behavioral Therapy for Borderline Personality Disorder” in Personality Disorders: Theory, Research, and Treatment. Here are the abstract and impact statements:
Despite nearly 30 years of research demonstrating its effectiveness in the treatment of borderline personality disorder (BPD) and related problems, few studies have investigated mechanisms of change for dialectical behavior therapy (DBT; Linehan, 1993a). Improvements in mindfulness and emotion regulation have been highlighted as key potential mechanisms of change in DBT (Lynch et al., 2006). The present study examined the time course of and associations between mindfulness, emotion regulation, and BPD symptoms during DBT. Participants were 240 repeatedly and recently self-harming adults (Mage = 27.75) with BPD who were randomly assigned to receive either 6 or 12 months of standard DBT. Primary hypotheses were that: (a) changes in mindfulness would occur before changes in emotion regulation, and (b) changes in emotion regulation would mediate the association of changes in mindfulness with changes in BPD symptoms. Results from changepoint analysis illuminated the proportion of participants for whom first changes occurred in emotion regulation (40.7%), mindfulness (32.4%), or both (26.9%). Contrary to hypotheses, five-wave, cross-lagged analyses did not indicate mediational effects of either mindfulness or emotion regulation on the association of either variable with change in BPD symptoms. Supplemental analyses, however, suggested that changes in emotion regulation mediated the inverse association of changes in mindfulness with changes in BPD symptoms. Findings highlight patterns of change in key, proposed mechanisms of change in DBT and suggest important future research directions.
I think it’s important for researchers to publish findings that are not consistent with their hypotheses. Here, changes in emotion regulation occurred first for more participants and changes in emotion regulation seemed to mediate the relationship between increased mindfulness and fewer BPD symptoms. This is a fairly large sample with clear needs for therapy to reduce self-harming behaviors.
Finally, Oshin, Silamongkol, Pucker, Finkelstein, King & Rizvi (2023) published “… And We Could Do Better: Comparing the efficacy of dialectical behavior therapy between LGBQ and heterosexual adults with borderline personality disorder” in Professional Psychology: Research and Practice. The abstract and impact statements are as follows:
The present study compared the efficacy of dialectical behavior therapy (DBT) for lesbian, gay, bisexual, and queer (LGBQ) and heterosexual adults who were diagnosed with borderline personality disorder (BPD). Clients were 100 clients (n = 35 LGBQ and n = 70 heterosexual) who participated in a 6-month comprehensive DBT program. The study had two aims: (a) to examine change in outcomes within LGBQ clients and (b) to compare outcomes between LGBQ and heterosexual clients. Results demonstrated that LGBQ clients reported significant decreases in BPD symptoms, depressive symptoms, general psychopathology, functional impairment, emotion dysregulation, and dysfunctional coping. LGBQ clients also reported significant increases in DBT skills use. Comparisons between LGBQ and heterosexual clients found that, while LGBQ clients experienced significant decreases in all measures of psychopathology, they had significantly less change than heterosexual clients for depressive symptoms, functional impairment, emotion dysregulation, and dysfunctional coping. Additionally, the rate of increases in DBT skills use was significantly lower among LGBQ clients. While DBT is likely effective in reducing symptoms associated with BPD among LGBQ clients, results suggest that improvement in some symptoms may be less in comparison to heterosexual clients. Recommendations to enhance the effectiveness for DBT for the specific challenges that LGBQ clients may face are discussed.
This study found that dialectical behavior therapy, a treatment for individuals struggling with suicidal and self-harm thoughts and behaviors, is effective for lesbian, gay, bisexual, and queer (LGBQ) adults. There was evidence that reductions in some treatment outcomes were slower for LGBQ in comparison to heterosexual clients, suggesting there is still work to be done to improve dialectical behavior therapy (DBT) treatment outcomes for LGBQ adults.
Like the previous study, this one examines self-harm, finding that, while dialectical behavior therapy is promising for LGBQ persons with BPD, their progress in therapy may be slower than for heterosexual clients.