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Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients

Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients Abstract • 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. References 1. Kass F, Skodol A, Charles E, Spitzer RL, Williams JBW. Scaled ratings of DSM-III personality disorders . Am J Psychiatry . 1985;142:627-630. 2. Piersma HL. The MCMI as a measure of DSM-III Axis II diagnoses: an empirical comparison . J Clin Psychol . 1987;43:478-483.Crossref 3. Cowdry R, Gardner DL. Pharmacotherapy of borderline personality disorder . Arch Gen Psychiatry . 1988;45:111-119.Crossref 4. Gunderson JG. Pharmacotherapy for patients with borderline personality disorder . Arch Gen Psychiatry . 1986;4:698-700.Crossref 5. Pope HG, Jonas JM, Hudson JI, Cohen BM, Gunderson JG. The validity of DSM-III borderline personality disorder . Arch Gen Psychiatry . 1983;40:23-30.Crossref 6. Clarkin JF, Widiger TA, Frances A, Hurt SW, Gilmore M. Prototype typology and the borderline personality disorder . J Abnorm Psychol . 1983;92:263-275.Crossref 7. Cowdry RW, Pickar D, Davies R. Symptoms and EEG findings in the borderline syndrome . J Psychiatry Medicine . 1985;15:201-211.Crossref 8. Stone MH. The course of borderline personality disorder . In: Tasman A, Hales RE, Frances AJ, eds. American Psychiatric Press Review of Psychiatry . Washington, DC: American Psychiatric Press Inc; 1987;8:103-122. 9. Liberman RP, Eckman T. Behavior therapy vs insightoriented therapy for repeated suicide attempters . Arch Gen Psychiatry . 1981;38:1126-1130.Crossref 10. Thompson LW, Gallagher D, Czirr R. Personality disorder and outcome in the treatment of later life depression . J Geriatr Psychiatry Neurol . 1988;121:133-146. 11. Turner RM. The effects of personality disorder diagnosis on the outcome of social anxiety symptom reduction . J Pers Disord . 1987;1:136-143.Crossref 12. Linehan MM. Dialectical behavior therapy for borderline personality disorder: theory and method . Bull Menninger Clin . 1987;51:261-276. 13. Linehan MM. Dialectical behavior therapy: a cognitive behavioral approach to parasuicide . J Pers Disord . 1987;1:328-333.Crossref 14. Linehan MM. Cognitive-Behavioral Treatment for Borderline Personality Disorder: The Dialectics of Effective Treatment . New York, NY: Guilford Press. In press. 15. Richman J, Charles E. Patient dissatisfaction and attempted suicide . Community Ment Health J . 1976;12:301-305.Crossref 16. Gunderson JG. Borderline Personality Disorder . Washington, DC: American Psychiatric Press Inc; 1984. 17. Greer S, Bagley CR. Effect of psychiatric intervention in attempted suicide: a controlled study . BMJ . 1971;1:310-312.Crossref 18. Teasdale JD, Fennell MJV, Hibbert GA, Amies PL. Cognitive therapy for major depressive disorder in primary care . Br J Psychiatry . 1984;144:400-406.Crossref 19. Gunderson JG, Kolb JE, Austin V. The Diagnostic Interview for Borderlines . Am J Psychiatry . 1981;138:896-903. 20. Robins LN, Helzer JE, Croughan J, Williams JB, Spitzer RL. NIMH Diagnostic Interview Schedule: Version III . St Louis, Mo: Washington University School of Medicine; 1981. 21. Linehan MM, Wagner AW, Cox G. Parasuicide History Interview: Comprehensive Assessment of Parasuicidal Behavior . Seattle, Wash: University of Washington; 1989. 22. Linehan MM. Dialectical Behavior Therapy for Treatment of Parasuicidal Women: Treatment Manual . Seattle, Wash: University of Washington; 1984. 23. Linehan MM. Treatment History Interview (THI) . Seattle, Wash: University of Washington; 1987. 24. Schotte DE, Clum GA. Suicide ideation in a college population . J Consult Clin Psychol . 1982;50:690-696.Crossref 25. Beck AT, Ward CH, Mendelson M, Mock J, Erlbaugh J. An inventory for measuring depression . Arch Gen Psychiatry . 1961;41:561-571.Crossref 26. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale . J Consult Clin Psychol . 1974;6:861-865.Crossref 27. Linehan MM, Goodstein JL, Nielsen SL, Chiles JA. Reasons for staying alive when you're thinking of killing yourself: the reasons for living inventory . J Consult Clin Psychol . 1983;51:276-286.Crossref 28. Waldinger R, Gunderson JG. Completed psychotherapies with borderline patients . Am J Psychother . 1984;38:190-202. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients

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References (34)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1991.01810360024003
Publisher site
See Article on Publisher Site

Abstract

Abstract • 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. References 1. Kass F, Skodol A, Charles E, Spitzer RL, Williams JBW. Scaled ratings of DSM-III personality disorders . Am J Psychiatry . 1985;142:627-630. 2. Piersma HL. The MCMI as a measure of DSM-III Axis II diagnoses: an empirical comparison . J Clin Psychol . 1987;43:478-483.Crossref 3. Cowdry R, Gardner DL. Pharmacotherapy of borderline personality disorder . Arch Gen Psychiatry . 1988;45:111-119.Crossref 4. Gunderson JG. Pharmacotherapy for patients with borderline personality disorder . Arch Gen Psychiatry . 1986;4:698-700.Crossref 5. Pope HG, Jonas JM, Hudson JI, Cohen BM, Gunderson JG. The validity of DSM-III borderline personality disorder . Arch Gen Psychiatry . 1983;40:23-30.Crossref 6. Clarkin JF, Widiger TA, Frances A, Hurt SW, Gilmore M. Prototype typology and the borderline personality disorder . J Abnorm Psychol . 1983;92:263-275.Crossref 7. Cowdry RW, Pickar D, Davies R. Symptoms and EEG findings in the borderline syndrome . J Psychiatry Medicine . 1985;15:201-211.Crossref 8. Stone MH. The course of borderline personality disorder . In: Tasman A, Hales RE, Frances AJ, eds. American Psychiatric Press Review of Psychiatry . Washington, DC: American Psychiatric Press Inc; 1987;8:103-122. 9. Liberman RP, Eckman T. Behavior therapy vs insightoriented therapy for repeated suicide attempters . Arch Gen Psychiatry . 1981;38:1126-1130.Crossref 10. Thompson LW, Gallagher D, Czirr R. Personality disorder and outcome in the treatment of later life depression . J Geriatr Psychiatry Neurol . 1988;121:133-146. 11. Turner RM. The effects of personality disorder diagnosis on the outcome of social anxiety symptom reduction . J Pers Disord . 1987;1:136-143.Crossref 12. Linehan MM. Dialectical behavior therapy for borderline personality disorder: theory and method . Bull Menninger Clin . 1987;51:261-276. 13. Linehan MM. Dialectical behavior therapy: a cognitive behavioral approach to parasuicide . J Pers Disord . 1987;1:328-333.Crossref 14. Linehan MM. Cognitive-Behavioral Treatment for Borderline Personality Disorder: The Dialectics of Effective Treatment . New York, NY: Guilford Press. In press. 15. Richman J, Charles E. Patient dissatisfaction and attempted suicide . Community Ment Health J . 1976;12:301-305.Crossref 16. Gunderson JG. Borderline Personality Disorder . Washington, DC: American Psychiatric Press Inc; 1984. 17. Greer S, Bagley CR. Effect of psychiatric intervention in attempted suicide: a controlled study . BMJ . 1971;1:310-312.Crossref 18. Teasdale JD, Fennell MJV, Hibbert GA, Amies PL. Cognitive therapy for major depressive disorder in primary care . Br J Psychiatry . 1984;144:400-406.Crossref 19. Gunderson JG, Kolb JE, Austin V. The Diagnostic Interview for Borderlines . Am J Psychiatry . 1981;138:896-903. 20. Robins LN, Helzer JE, Croughan J, Williams JB, Spitzer RL. NIMH Diagnostic Interview Schedule: Version III . St Louis, Mo: Washington University School of Medicine; 1981. 21. Linehan MM, Wagner AW, Cox G. Parasuicide History Interview: Comprehensive Assessment of Parasuicidal Behavior . Seattle, Wash: University of Washington; 1989. 22. Linehan MM. Dialectical Behavior Therapy for Treatment of Parasuicidal Women: Treatment Manual . Seattle, Wash: University of Washington; 1984. 23. Linehan MM. Treatment History Interview (THI) . Seattle, Wash: University of Washington; 1987. 24. Schotte DE, Clum GA. Suicide ideation in a college population . J Consult Clin Psychol . 1982;50:690-696.Crossref 25. Beck AT, Ward CH, Mendelson M, Mock J, Erlbaugh J. An inventory for measuring depression . Arch Gen Psychiatry . 1961;41:561-571.Crossref 26. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale . J Consult Clin Psychol . 1974;6:861-865.Crossref 27. Linehan MM, Goodstein JL, Nielsen SL, Chiles JA. Reasons for staying alive when you're thinking of killing yourself: the reasons for living inventory . J Consult Clin Psychol . 1983;51:276-286.Crossref 28. Waldinger R, Gunderson JG. Completed psychotherapies with borderline patients . Am J Psychother . 1984;38:190-202.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Dec 1, 1991

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