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Clinical Research
Center
Dialectical
Behavior Therapy
Dialectical
Behavior Therapy (DBT-D) for
Treatment of the Multi- Problem Elderly Depressed Patient
Pilot data examining the efficacy of a PARTIAL
DBT-D intervention (Skills
Training plus medication) vs.
TAU (Treatment as Usual; medication plus clinical management) for
the treatment of depression in the elderly has been ongoing since
mid-August 1997. This study
has been has been supported by the Duke Clinical Research Center for the
Study of Depression in Late Life and funded by NIMH, Walker Inman
Memorial funds, and the John A. Hartford Foundation.
Dialectical
Behavior Therapy (DBT) has been chosen as the psychotherapeutic
intervention because it contains specific empirically tested methodology
designed to treat multi-problem patients.
In addition, DBT specifically addresses difficulties, which are
common when treating personality-disordered elderly (e.g., suicidal
behavior, complicated grief, non-compliance, interpersonal difficulties,
attentional control difficulties, skill generalization issues).
The
target population for DBT-D interventions are elderly depressed patients
(generally 60+ years of age) who may have a comorbid personality
disorder and/or have failed to respond to depression specific
interventions. The modes of
treatment in DBT-D are similar to those in standard DBT.
The treatment ideally includes three phases and the completion of
all three phases take approximately one year.
The Acute Phase of treatment requires six months and
includes weekly individual psychotherapy, weekly group skills training,
telephone consultation as needed, and weekly consultation team meetings.
Following this, (assuming depression remission and/or clinical
improvement) a Continuation Phase occurs which includes
twice-monthly individual psychotherapy for three months.
The goal of this phase is to further solidify skills application
and generalization. The patient then begins three months of a Maintenance
Phase. This phase
includes one individual psychotherapy session per month targeted at
furthering skills application and generalization, as well as planning
for termination. Both the Continuation and Maintenance Phases also include
patient telephone consultation as needed and weekly therapist
consultation team meetings
For the current pilot study, the psychotherapeutic
intervention primarily consists of DBT skills training and
is based on a modified version of the manualized skills training
protocol developed by Linehan (1993).
To be included in this pilot study, a participant must meet
criteria for a current episode of Major Depressive Disorder (DIS;
Diagnostic Interview Schedule; Robins, Helzer, Croughan, & Ratcliff,
1979) and score at least within the moderately depressed range on the
17-item Hamilton Rating Scale for Depression (HAM-D:Hamilton, 1960) or
Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery, 1979).
Participants must also be cognitively intact, willing to begin a
course of psychopharmacological treatment, and willing to suspend all
other psychotherapy treatments during the duration of the treatment
phase of the study. Potential
participants are excluded if they are found to have a coexisting
bipolar, psychotic, or primary substance abuse disorder, evidence of an
organic etiology, a coexisting medical condition which is judged by
medical review to potentially affect depressive symptoms, and/or are
undergoing ECT treatment.
Preliminary results on a sample of 26 participants (DBT-D,
n = 15; TAU; n = 11) have been presented elsewhere (Lynch et al., 1998).
Results suggest that DBT-D may be particularly useful for the patient
with chronic maladaptive behaviors, and that DBT-D shows promise in
improving factors associated with being dependent on others and overly
concerned with being liked, reactivity to the social environment,
adaptive coping, and emotional intensity and experience in general.
Future research is being developed which will examine
the efficacy of providing the full DBT-D model (individual, group skills
training, telephone crisis availability, and consultation team) for
efficacy in treating elderly depressed patients selected on the basis of
a diagnosis of comorbid personality disorder and failure to respond to a
course of anti-depressant medication.
For more information, please contact the principal
investigator, Dr. Thomas R. Lynch at 919-479-2080 or email: lynch011@mc.duke.edu.
If you have patients to refer to this free treatment, please
contact Carrie Dombeck in the Duke Clinical Research Center for the Study of
Depression in Late Life at 919-684-4123.
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