Fromeside Dialectical Behaviour Therapy Programme

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Fromeside Dialectical Behaviour Therapy Programme

• Dr Michelle Chauhan
• Clinical Psychologist
• Fromeside

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Plan

• Overview of DBT
• Fromeside DBT Programme

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What is DBT?

• Developed for BPD in US by Linehan (1993)
• Cognitive-Behavioural approach
• Dialectics and Validation added
• Active skills-orientated therapy
• Collaborative
• Goal eliminate life-threatening behaviours

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Dialectical

• Describes poles and extreme positions
• Acknowledges the grain of truth in each position
• Having two opposing positions and working towards
  middle (synthesis) to bring about change
• Avoid getting stuck in extreme positions
• (Dialectical Dilemmas and resolutions are key to
  team functioning).

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Why DBT for a forensic population?

• High incidence of PD (50-70)
• Evidence base for BPD (Linehan et al, 1991
  Linehan et al, 1999)
• Emerging evidence for DBT for ASPD (McCann et al,
  2000 Evershed et al, 2003)
• Treatment with a clear behavioural hierarchy

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Why DBT for a forensic population?

• Systematic treatment of life-threatening or
  aggressive behaviours
• Addresses staff burnout and behaviour that
  interferes with conduct of effective treatment
• Forensic patients more difficult to engage,
  higher attrition rates, poorer outcomes

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The Fromeside DBT Team

• Dr Michelle Chauhan, Clinical Psychologist (and
  Team Leader)
• Gerrie Holloway, Consultant Clinical Psychologist
  (and Clinical Supervisor)
• Jeff Roche RMN

• Dr Meyrem Musa, Clinical Psychologist
• Dr Amy Watts, Clinical Psychologist
• Rebecca Knight, Occupational Therapist
• Weekly Team Consultation

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Process of DBT

• Assessment (2-3 sessions)
• Problems, goals, diagnostics
• Pre-Treatment (4-6 sessions)
• Commitment to treatment (agreements)
• Reduce drop-out
• Clarify goals
• Orient and expose to model

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Treatment - Individual

• Individual weekly therapy (12 months)
• Diary card
• Target hierarchy
• Behaviour solution analysis of life-threatening
  and aggressive behaviour

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Treatment - Group

• Skills Training Group (12 months weekly)
• Acquisition and strengthening of skills
• Mindfulness
• Distress Tolerance
• Emotion regulation
• Interpersonal Effectiveness
• Add Crime Review for ASPD group?

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Stage 1 Treatment Behaviour Control

• Target Hierarchy
• Decrease suicidal, parasuicidal and violent
  thoughts, behaviour, urges
• Behaviours that interfere with therapy (TIBs)
• Quality of Life problems - Related to Axis I
  disorders or risk issues
• Increasing behavioural skills

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• BPD (DSM-IV) at least 5 of following

1. A pattern of intense and unstable
interpersonal relationships 2. Frantic efforts
to avoid real or imagined abandonment (not
including self-harm) 3. Identity disturbance
4. Impulsivity which is potentially
self-damaging 5. Recurrent suicidal or
para-suicidal behaviour 6. Affective
instability 7. Chronic feelings of
emptiness 8. Inappropriate or uncontrollable
anger 9. Transient stress-related paranoid
ideation or severe dissociative symptoms
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ASPD (DSM-IV)

• A pervasive pattern of disregard for violation
  of rights of others since age 15 years, as
  indicated by 3 (or more) of the following
• Failure to confirm to social norms with respect
  to lawful behaviours as indicated by repeatedly
  performing acts that are grounds for arrest.
• Deceitfulness, Impulsivity or failure to plan
  ahead, Irritability and aggressiveness, Reckless
  disregard for safety of self or others,
  Consistent irresponsibility, Lack of remorse
• The individual is at least 18 years.
• There is evidence of Conduct Disorder onset
  before 15 years of age.
• The occurrence of antisocial behaviour is not
  exclusively during the course of schizophrenia or
  a manic episode.

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Outcomes

• 1 patient successfully completed treatment
• 2 patients currently in treatment
• 4 awaiting assessment
• Further modifications for predicted ASPD group?