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Evaluating the Effectiveness of a Dialectical Behaviour Therapy (DBT) Informed Programme in a Community Perinatal Team

Published online by Cambridge University Press:  25 January 2018

Hannah Wilson*
Affiliation:
Southern Health NHS Foundation Trust, Specialist Perinatal Mental Health Team, Melbury Lodge Mother and Baby Unit, Winchester, UK
Alexandra L. Donachie
Affiliation:
Southern Health NHS Foundation Trust, Specialist Perinatal Mental Health Team, Melbury Lodge Mother and Baby Unit, Winchester, UK
*
Correspondence to Dr Hannah Wilson, Mother and Baby Unit, Melbury Lodge, Royal Hampshire County Hospital, 61 Romsey Road, Winchester, Hampshire SO22 5DL. E-mail: [email protected]

Abstract

Background: Adapted DBT programmes have been well documented but little has been published on such programmes in the perinatal period. Aim: To assess the effectiveness of a stand-alone DBT skills group for perinatal women with emotion dysregulation. Method: A stand-alone DBT-informed skills training group was offered to 21 women with emotional dysregulation under the care of a perinatal community mental health team; 14 completed the programme. Staff received support via a consultation group. Modules included mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness adapted to the specific demands of parenting infants. Outcome measures were collected at three time points: assessment, start of the group and at the end. Results: Statistical analysis showed significant reduction in CORE scores over the intervention period (t (13) = 5.32, p < .001; Cohen's d = 0.83), with similar effects on the Mental Health Confidence Scale (t (13) = ‒8.03, p < .001, Cohen's d = 0.83) and Living with Emotions Scale (t (13) = ‒9.42, p < .001, Cohen's d = 0.93). There were no significant changes on these three measures from assessment to start of the group. Conclusions: In this uncontrolled study, the intervention period was associated with reduced distress, increased confidence and ability to regulate emotion. Recommendations for continuing this model of service delivery are made. Further research is needed.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

Brockington, I. F., Fraser, C. and Wilson, D. (2006). The Postpartum Bonding Questionnaire: a validation. Archives of Women's Mental Health, 9, 233242.Google Scholar
Carpinello, S. E., Knight, E. L., Markowitz, F. E. and Pease, E. L. (2000). The development of the mental health confidence scale: a measure of self-efficacy in individuals diagnosed with mental disorders. Psychiatric Rehabilitation Journal, 23, 236243.Google Scholar
Carter, G., Willcox, C., Lewin, T., Conrad, A. and Bendit, N. (2010). Hunter DBT project: randomised control trial of dialectical behaviour therapy in women with borderline personality disorder. Australian and New Zealand Journal of Psychiatry, 44, 162173.Google Scholar
Clarke, I. (2008). Pioneering a cross diagnostic approach founded in cognitive science. In Clarke, I. and Wilson, H. (eds), Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; Working with Clients, Staff and the Milieu. London: Routledge.Google Scholar
Clarke, I. and Wilson, H. (2008). Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; Working with Clients, Staff and the Milieu. London: Routledge.Google Scholar
Cox, J., Murray, D. and Chapman, G. (1993). A controlled study of the onset, prevalence and duration of postnatal depression. British Journal of Psychiatry, 16, 2741.Google Scholar
Crittenden, P. M. (1988). Relationships at risk. In Belsky, J. and Nezworski, T. (eds), The Clinical Implications of Attachment, (pp. 136174). Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Cromwell, S. E., Beauchaine, T. P. and Lenzenweger, M. F. (2008). The development of borderline personality and self injurious behaviour. In Beauchaine, T. P. and Hinshaw, S. (eds), Child Psychopathology. Hoboken, NJ: Wiley.Google Scholar
Davies, R. L., Heslop, P., Onyett, S. and Soteriou, T. (2014). Effective support for those who are ‘hard to engage’: a qualitative user-led study. Journal of Mental Health, 23, 6266.Google Scholar
Davies, A., McIvor, R. and Kumar, C. (1995). Impact of childbirth on a series of schizophrenic mothers: a comment on the possible influence of oestrogen on schizophrenia. Schizophrenia Research, 16, 2531.Google Scholar
Evans, C. E., Mellor-Clark, J., Margison, F. et al. (2000). Clinical Outcomes in Routine Evaluation: the CORE Outcome Measure (CORE-OM). Journal of Mental Health, 9, 247255.Google Scholar
Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J. and Audin, K. (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. British Journal of Psychiatry, 18, 5160.Google Scholar
Fraiberg, S., Adelson, E. and Shapiro, V. (1975). Ghosts in the nursery. A psychoanalytic approach to the problems of impaired infant-mother relationships. Journal of American Academic Child Psychiatry, 14, 387421.Google Scholar
Gerhardt, S. (2014). Why Love Matters: How Affection Shapes a Baby's Brain. London: Routledge.Google Scholar
Gratz, K. and Roemer, L. (2004). Multidimensional assessment of emotional regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology, and Behavioral Assessment, 26, 4154.Google Scholar
Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmstrom, A., Johnson, A. et al. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training groups: results from a randomised control trial. Behaviour Research and Therapy, 49, 175185.Google Scholar
Johns, S. and Belsky, J. (2007). Life transitions and becoming a parent. In Salmon, C. and Shackelford, T. (eds), Family Relationships: An Evolutionary Perspective. Oxford: Oxford University Press.Google Scholar
Jones, I. and Craddock, N. (2005). Bipolar disorder and childbirth – the importance of recognising risk. British Journal of Psychiatry, 186, 453454.Google Scholar
Knight, M., Tuffnell, D., Kenyon, S., Shakespeare, J., Gray, R. and Kurinczuk, J. J. (2015). MBRRACE. Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011–13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–13. Oxford: National Perinatal Epidemiology Unit, University of Oxford.Google Scholar
Linehan, M. (1993). Cognitive Behavioural Treatment of Borderline Personality Disorder. New York: Guildford Press.Google Scholar
Linehan, M. (2015a). DBT Skills Training Manual, second edition. New York: Guildford Press.Google Scholar
Linehan, M. (2015b). DBT Skills Training Handouts and Worksheets, second edition. New York: Guildford Press.Google Scholar
Linehan, M., Armstrong, H., Suarez, A., Allmon, D. and Heard, H. (1991). Cognitive behavioural treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 10601064.Google Scholar
Linehan, M., Comtois, K., Murray, A., Brown, M., Gallop, R. and Heard, H. (2006). Two year randomised trial and follow up of dialectical behaviour therapy vs. therapy by experts for suicidal behaviour and borderline personality disorder. Archives of General Psychiatry, 63, 757766.Google Scholar
Murray, L. and Andrews, L. (2000). The Social Baby: Understanding Babies Communication from Birth. Richmond, UK: CP Publishing.Google Scholar
National Health Service Five Year Forward View (2014). Available online at: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 18 June 2017).Google Scholar
Neacsiu, A., Rizvi, S., Vitaliano, P., Lynch, T. and Linehan, M. (2010). The Dialectical Behavior Therapy Ways of Coping Checklist; development and psychometric properties. Journal of Clinical Psychology, 66, 120.Google Scholar
O'Donnell, K., Glover, V., Barker, E. and O'Connor, T. (2014). The persisting effect of maternal mood in pregnancy on childhood psychopathology. Development and Psychopathology, 26, 393403.Google Scholar
O'Hara, M. W. and Swain, A. M. (1996). Rates and risk of postpartum depression – a meta-analysis. International Review of Psychiatry, 8, 3754.Google Scholar
Pawlby, S., Hay, D., Sharp, D., Waters, C. and Keane, V. (2009). Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study. Journal of Affective Disorders, 113, 236243.Google Scholar
Pickles, A., Sharp, H., Hellier, J. and Hill, J. (2013). Prenatal anxiety, maternal stroking in infancy, and symptoms of emotional and behavioural disorders at 3.5 years. European Child Adolescent Psychiatry, 26, 325334.Google Scholar
Sambrook, S., Abba, N. and Chadwick, P. (2006). Evaluation of DBT emotional coping skills groups for people with parasuicidal behaviours. Behavioural and Cognitive Psychotherapy, 35, 241244.Google Scholar
Sameroff, A. (1993). The Transactional Model of Development: How Children and Contexts Shape Each Other. London: American Psychological Association.Google Scholar
Schacht, R. Hammond, L. Marks, M., Woods, B. and Conroy, S. (2012). The relation between mind-mindedness in mothers with borderline personality disorder and mental state understanding in their children. Infant and Child Development, 22, 6884.Google Scholar
Sharma, A. and Cockerill, H. (2014). Mary Sheridan's From Birth to Five Years: Children's Developmental Progress. London: Routledge Press.Google Scholar
Soler, J., Pascal, J., Tiana, T., Cebrai, A., Barachina, J., Campins, M. et al. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3 month randomised control trial. Behaviour Research and Therapy, 47, 353358.Google Scholar
Squires, J., Bricker, D. and Twombly, E. (2002). Ages and Stages Questionnaires: Social-Emotional (ASQ: SE), a parent-completed, child-monitoring system for social-emotional behaviours. Baltimore: Paul H. Brookes Publishing.Google Scholar
Swift, J. K. and Greenberg, R.P. (2012). Premature discontinuation in adult psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology, 80, 547559.Google Scholar
Telch, C. F., Agras, W. S. and Linehan, M. M. (2001). Dialectical behaviour therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 10611065.Google Scholar
Whiteside, U. (2011). A brief personalised feedback intervention integrating a motivational interviewing therapeutic style and DBT skills for depressed or anxious heavy drinking young adults. Unpublished doctoral thesis dissertation, University of Washington.Google Scholar
Zlotnick, C., Donaldson, D., Spirito, A. and Pearlstein, T. (1997). Affect regulation and suicide attempts in adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 793798.Google Scholar
Zlotnick, C., Wolfsdorf, B. A., Johnson, B. and Spirito, A. (2003). Impaired self-regulation and suicidal behavior among adolescent and young adult psychiatric inpatients. Archives of Suicide Research, 7, 149157.Google Scholar
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