Center for Behavioral Medicine

At the Center for Behavioral Medicine we are committed to delivering the most effective patient care possible.  We feel it is important to know if our clients are getting better with the treatment we do.  So, we invite you to participate in completing research protocols to determine if the treatment you are participating in is actually working.  All data is confidential and is analyzed using ID numbers instead of any identifying personal information.

Our goal is to reduce symptom severity and improve your ability to create the life you want.  We present our treatment results at professional conferences around the country.  Our intention is to promote confidence in our clients, as well as in the professional community, that expertly delivered services produce results.  We even use data about your improvements to influence insurance companies to see the value of on-going treatment.

The services delivered in our Dialectical Behavior Therapy (DBT) Program are measured on a monthly basis.  The "poster" below is one that was presented at a conference in 2005.  It clearly demonstrates that our clients experience lower levels of depression, hopelessness, suicidal actions and physical symptoms with treatment.

A Preliminary Evaluation of Dialectical Behavior Therapy
in a Naturalistic Setting
Janet M. Johnson¹, Brandon B. Hayes¹, Joan C. Russo², & Jonathan W. Kanter¹
1 University of Wisconsin, Milwaukee,    2 Center for Behavioral Medicine

Introduction

•         This study set out to evaluate the immediate effectiveness of a comprehensive Dialectical Behavior Therapy (DBT) program in a naturalistic, hospital-based setting.  ()Note: the DBT program was moved in July, 2005 from Columbia St. Mary’s to the Center for Behavioral Medicine.

•         A growing body of research using randomized clinical controlled trials demonstrates the efficacy of DBT in a variety of settings with a variety of populations (Hayes, Masuda, & Bissett, 2004; Koerner, 2000; Robins & Chapman, 2004).  As this research continues, clinicians in naturalistic settings are being trained to implement DBT in these settings.    

•         Given this context, it is important to evaluate the effectiveness of DBT as implemented by trained clinicians in other than university settings.

•         The current study assesses changes in parasuicidal and suicidal behaviors as well as in general psychological improvement as measured by scales assessing depression, hopelessness, and physical symptoms. 

•         The current study predicted that (1) individuals will report significant decreases on parasuicidal and suicidal behaviors from intake to month two, and (2) individuals will report significant improvements in the measures of general psychological functioning (depression, hopelessness, and physical symptoms) from intake to month four.

•         Twenty-four individuals (23 females) in a comprehensive DBT program participated in this study (average age = 42; range: 19 – 61).

•         Twenty individuals met the diagnostic criteria for Borderline Personality Disorder.

•         Twenty participants met the criteria for a co-morbid Axis I disorder (16 individuals with a mood disorder, 2 with an anxiety disorder, 2 with an eating disorder, and 1 a substance-related disorder).

•         To date, 5 individuals (18%) dropped out of treatment.  Their data were not included in these analyses.

•         At intake, all individuals participated in a diagnostic interview (SCID-I and SCID-II) and completed self-report measures including the Beck Depression Inventory (BDI; possible scores from 0-60), Beck Hopelessness Scale (BHS; scores from 0-20), and the Brief Symptom Inventory (BSI; scores from 0-208).

•         Participants completed the self-report measures monthly.

•         Additionally, individuals maintained a weekly diary card on which they tracked self-harm urges and actions (reported as a daily count), suicidal ideation (0-5, 0 = no ideation, 5 = constant ideation). 

•         Per Linehan (1993), participants attended weekly individual psychotherapy and group skills training sessions.

Clinical Staff

•         The comprehensive DBT staff include: a psychiatrist, two psychologists, four clinical social workers, five master’s level clinicians, and an occupational therapist.

•         Three of the consultation team members completed the 10-day DBT Intensive training, four completed the five-day Intensive for team members, one completed a five-day Individual DBT Intensive training, and eight completed a two-day DBT workshop.

•         They possess an average of 11.1 years of general clinical experience (range: 4 – 27 years).

•         To test for improvements in parasuicidal and suicidal behavior, three paired samples t tests were computed.

•         Results indicate a significant decrease in self-harm behaviors, t (23) = 2.46, p < .05, but non-significant decreases in urges to self-harm or in suicidal ideation.

•         Three paired samples t tests to examine for general psychological improvements from intake to month four revealed significant decreases in depression, hopelessness, and physical symptoms, t (23) = 5.29, p < .001, t (22) = 3.09, p < .01, and t (23) = 2.65, p < .01, respectively.

Table 1. Mean (SD) self-harm urges, self-harm actions, and suicidal ideation at Intake and Month #2

Table 2. Mean (SD) monthly levels of depression (BDI), hopelessness (BHS), and physical symptoms (BSI)

Discussion

•         The primary goal of DBT is to decrease parasuicidal and suicidal behavior, and that is what our program appears to have accomplished within the first four months of treatment. This is especially important since self-harm urges and suicidal ideation had not decreased to the same degree.

•         Furthermore, the results demonstrate significant improvements in levels of depression, hopelessness, and physical symptoms by month four.

•         These results support the effectiveness of DBT in a naturalistic setting, both in terms of general psychological and DBT-relevant symptom improvements.

•         A potential limitation of the study includes the lack of a comparison group, which leaves us unable to assess what changes might occur through an alternate treatment.

References

Hayes, S., Masuda, A., & Bissett, R. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35 (1), 35-54.

Koerner, K. (2000). Further data on dialectical behavior therapy. Clinical Psychology: Science and Practice, 7 (1), 104-112.

Linehan, M.M. (1993).  Cognitive-behavioral treatment of borderline personality disorder.  New York, NY: Guilford Press.

Linehan, M.M., Armstrong, H.E., Suarez, A., Allmon, D., & Heard, H.L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060-1064.

Robins, C. & Chapman, A. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18 (1), 73-89.

Our Location: 

We are located at 250 N Sunnyslope Road, Suite 128 in Brookfield, Wisconsin.  We are one mile east of Brookfield Square Mall in the Bishop's Woods area.

Directions:

From downtown Milwaukee heading west:  Take I-94 west to exit 301 North (Moorland Road).  At the first intersection (Blue Mound Road) turn right and head east for one mile.  At the traffic signal turn right (Sunnyslope Road) heading south.  Turn at the second driveway on your left.  This is Maplewood Executive Center.  We are on the first floor (Suite 128) across from the restrooms and next to Suite 150.

From the western suburbs:  Take I-94 east and exit at the Moorland Road north exit.  Continue with the above directions from there.  Call 262-782-2820 with any questions.