Treatment of Automatic Negative Thoughts and Non-suicidal Self-injury (NSSI) Behavior in Borderline Personality Disorder Adolescents: Dialectical Behavior Therapy
Authors
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Misagh Norouzi Esfahani
MSc in clinical Psychology, Department of Psychology, Isfahan(Khorasgan) Branch, Islamic Azad University, Isfahan,iran .
https://orcid.org/0000-0003-3600-6079
-
Fatemeh Hasirchaman
MSc in counseling, Department of psychology and counseling, kermanshah Branch,islamic Azad university,kermanshah,iran.
https://orcid.org/0000-0003-3140-6196
-
Vida Shahdadian Naeini
Master of science in Positive Psychology, Nain Branch, Islamic Azad university, Iran.
https://orcid.org/0000-0002-0371-3319
-
Latifeh Sharifpour
MSc in General Psychology, Department of Psychology, Faculty of Humanities and Literature, Shahid Bahonar University of Kerman, Kerman, Iran.
https://orcid.org/0000-0003-3795-5006
-
Nafiseh Boorboor
Master of General Psychology, Department of Humanitis، Islamic Azad University Electronic Campus, Tehran, Iran.
https://orcid.org/0000-0002-3222-7993
-
Javad Seyed Jafari
PhD candidate in Psychology, Allameh Tabataba'i University, Tehran, Iran.
https://orcid.org/0000-0002-0447-1075
DOI:
https://doi.org/10.22100/ijhs.v8i2.900Keywords:
Automatic negative thoughts, Non-suicidal self-injury (NSSI) behavior, Borderline personality disorderAbstract
Background: About 17 to 80% of borderline personality disorder (BPD) patients suffer repeated NSSI (most frequently, cutting/burning self-injury), while 46 to 92% of BPD patients attempt suicide. This study aimed to investigate the effectiveness of the condensed dialectic behavior in reducing automatic negative thoughts and its positive effects on non-suicidal self-injury (NSSI) behavior in borderline personality disorder (BPD).
Methods: A semi-experimental study with pre-and post-tests is going on with both an experimental group and a control group. In 2019, twenty-two BPD adolescents who attended the treatment clinic) Masire Sabz), district 8, Tehran, were divided into two groups. Two questionnaires of automatic negative thoughts and non-suicidal suicide self-injury were administered before and after the intervention. This study employed SPSS 23 with Levene's test, as well as ANOVA to analyze the data. During the intervention group, twelve 90-minute sessions took place with participants in the intervention group, which followed a protocol adapted from a standard DBT protocol for BD participants in the control group waited for a treatment appointment.
Results: The results showed that the scores of the intervention group significantly decreased in the Automatic negative thoughts and non-suicidal self-injury after 2 months of the intervention (Pvalue<0.001).
Conclusions: It can be concluded that dialectical behavior therapy was effective on automatic negative thoughts and non-suicidal self-injury (NSSI) behavior among borderline personality disorder adolescents.
Keywords: Automatic negative thoughts, Non-suicidal self-injury (NSSI) behavior, Borderline personality disorder.
References
References
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2. Keller S, Stelmaszczyk K, Kolly S, de Roten Y, Despland JN, Caspar F, Drapeau M, Kramer U. Change in biased thinking in a treatment based on the motive-oriented therapeutic relationship for borderline personality disorder. Journal of personality disorders. 2018 Jan;32(Supplement):75-92.
3. Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behaviour research and therapy. 2005 Sep 1;43(9):1173-85
4. Sleuwaegen E, Houben M, Claes L, Berens A, Sabbe B. The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder:“Actions instead of words”. Comprehensive psychiatry. 2017 Aug 1;77:80-8.
5. Choi-kain L, Finch E, Masland S, Jenkins J, Unruh B. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007%2Fs40473-017-0103-z
6. Linehan MM. Dialectical behavioral therapy: A cognitive behavioral approach to parasuicide. Journal of Personality disorders. 1987 Dec;1(4):328-33.
7. Giordano C, Iannuzzi V, Danesi F, Poletti M. Feasibility and effectiveness of Dialectical-Behavior Therapy for patients with borderline personality disorder in Italian mental health services: a preliminary study. Rivista di Psichiatria. 2021 Jan 1;56(1):43-5.
8. Alavi N, Stephenson C, Rivera M. Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial. JMIR Mental Health. 2021 Apr 30;8(4):e27308.
9. Schaich A, Braakmann D, Rogg M, Meine C, Ambrosch J, Assmann N, Borgwardt S, Schweiger U, Fassbinder E. How do patients with borderline personality disorder experience Distress Tolerance Skills in the context of dialectical behavioral therapy?—A qualitative study. Plos one. 2021 Jun 15;16(6):e0252403.
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11. Ghorbani S, Kameneh AS, Motahedy A, Alipour Z. Comparative effectiveness of cognitive-behavioral therapy and dialectical behavior therapy on emotion regulation, positive and negative affection, aggressive and self-harm behaviors of 13-16-year-old female students. International Journal of Multicultural and Multireligious Understanding. 2020 Oct 1;7(9):20-32.
12. Lin TJ, Ko HC, Wu JY, Oei TP, Lane HY, Chen CH. The effectiveness of dialectical behavior therapy skills training group vs. cognitive therapy group on reducing depression and suicide attempts for borderline personality disorder in Taiwan. Archives of Suicide Research. 2019 Jan 2;23(1):82-99.
13. Stiglmayr C, Stecher-Mohr J, Wagner T, et al. Effectiveness of dialectic behavioral therapy in routine outpatient care: The Berlin Borderline Study. Bord Personal Disord Emot Dysregul. 2014;1(1):20. doi:10.1186/2051-6673-1-20
14. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry. 2015 May;72(5):475-82. doi:10.1001/jamapsychiatry.2014.3039
15. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour research and therapy. 2010;48(9):832–9. pmid:20579633
16. Zeifman RJ, Boritz T, Barnhart R, Labrish C, McMain SF. The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training. Personality Disorders: Theory, Research, and Treatment. 2019. pmid:31647267
17. Little H, Tickle A, das Nair R. Process and impact of dialectical behaviour therapy: A systematic review of perceptions of clients with a diagnosis of borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice. 2018;91(3):278–301.
18. Barnicot K, Couldrey L, Sandhu S, Priebe S. Overcoming barriers to skills training in borderline personality disorder: A qualitative interview study. PloS one. 2015;10(10). pmid:26465757
19. Hollon SD, Kendall PC. Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive therapy and research. 1980 Dec;4(4):383-95.
20. Kazdin AE. Evaluation of the Automatic Thoughts Questionnaire: Negative cognitive processes and depression among children. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Mar;2(1):73.
21. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the automatic thoughts questionnaire: ATQ-Persian. International Journal of Social Psychiatry. 2006; 52(2):127-137
22. Klonsky ED, Oltmanns TF, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry. 2003;160(8):1501-8. doi: 10.1176/appi.ajp.160.8.1501. [PubMed: 12900314]. [PubMed Central: PMC4362719].
23. Poorolajal J, Haghtalab T, Farhadi M, Darvishi N. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. J Public Health (Oxf). 2016;38(3):e282-91. doi: 10.1093/pubmed/fdv148.
24. Bildik T, Somer O, Kabukcu Basay B, Basay O, Ozbaran B. [The validity and reliability of the Turkish version of the inventory of statements about self-injury]. Turk Psikiyatri Derg. 2013;24(1):49-57.
25. Lindholm T, Bjarehed J, Lundh LG. Functions of nonsuicidal self-injury among young women in residential care: a pilot study with the Swedish version of the Inventory of Statements about Self-Injury. Cogn Behav Ther. 2011;40(3):183-9. doi: 10.1080/16506073.2011.565791.
26. Fox KR, Huang X, Guzmán EM, Funsch KM, Cha CB, Ribeiro JD, Franklin JC. Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological bulletin. 2020 Oct 29.
27. Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behaviour research and therapy. 2005 Sep 1;43(9):1173-85.
28. Afshari B, Omidi A, Ahmadvand A. Effects of dialectical behavior therapy on executive functions, emotion regulation, and mindfulness in bipolar disorder. Journal of Contemporary Psychotherapy. 2019 Oct 8:1-9.
29. Beck AT. Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of general psychiatry. 1963 Oct 1;9(4):324-33.
30. Beck AT. The current state of cognitive therapy: a 40-year retrospective. Archives of general psychiatry. 2005 Sep 1;62(9):953-9.
31. McCauley E, Berk MS, Asarnow JR, Adrian M, Cohen J, Korslund K, Avina C, Hughes J, Harned M, Gallop R, Linehan MM. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA psychiatry. 2018 Aug 1;75(8):777-85.
32. Elmaghraby R, Nobari O, Cullen KR. Treatment of non-suicidal self-injurious behavior in adolescents. Psychiatric Times. 2019 Nov;36(11):39-42.
33. Prada P, Perroud N, Rüfenacht E, Nicastro R. Strategies to deal with suicide and non-suicidal self-injury in borderline personality disorder, the case of DBT. Frontiers in psychology. 2018 Dec 17;9:2595.
1. Ramakrishnan R, Salleh NM. Teacher’s self-efficacy: A systematic review. International Journal of Academic Research in Business and Social Sciences. 2018 Dec;8(12):2379-402.
2. Keller S, Stelmaszczyk K, Kolly S, de Roten Y, Despland JN, Caspar F, Drapeau M, Kramer U. Change in biased thinking in a treatment based on the motive-oriented therapeutic relationship for borderline personality disorder. Journal of personality disorders. 2018 Jan;32(Supplement):75-92.
3. Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behaviour research and therapy. 2005 Sep 1;43(9):1173-85
4. Sleuwaegen E, Houben M, Claes L, Berens A, Sabbe B. The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder:“Actions instead of words”. Comprehensive psychiatry. 2017 Aug 1;77:80-8.
5. Choi-kain L, Finch E, Masland S, Jenkins J, Unruh B. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007%2Fs40473-017-0103-z
6. Linehan MM. Dialectical behavioral therapy: A cognitive behavioral approach to parasuicide. Journal of Personality disorders. 1987 Dec;1(4):328-33.
7. Giordano C, Iannuzzi V, Danesi F, Poletti M. Feasibility and effectiveness of Dialectical-Behavior Therapy for patients with borderline personality disorder in Italian mental health services: a preliminary study. Rivista di Psichiatria. 2021 Jan 1;56(1):43-5.
8. Alavi N, Stephenson C, Rivera M. Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial. JMIR Mental Health. 2021 Apr 30;8(4):e27308.
9. Schaich A, Braakmann D, Rogg M, Meine C, Ambrosch J, Assmann N, Borgwardt S, Schweiger U, Fassbinder E. How do patients with borderline personality disorder experience Distress Tolerance Skills in the context of dialectical behavioral therapy?—A qualitative study. Plos one. 2021 Jun 15;16(6):e0252403.
10. Kothgassner OD, Goreis A, Robinson K, Huscsava MM, Schmahl C, Plener PL. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological medicine. 2021 May 1:1-1.
11. Ghorbani S, Kameneh AS, Motahedy A, Alipour Z. Comparative effectiveness of cognitive-behavioral therapy and dialectical behavior therapy on emotion regulation, positive and negative affection, aggressive and self-harm behaviors of 13-16-year-old female students. International Journal of Multicultural and Multireligious Understanding. 2020 Oct 1;7(9):20-32.
12. Lin TJ, Ko HC, Wu JY, Oei TP, Lane HY, Chen CH. The effectiveness of dialectical behavior therapy skills training group vs. cognitive therapy group on reducing depression and suicide attempts for borderline personality disorder in Taiwan. Archives of Suicide Research. 2019 Jan 2;23(1):82-99.
13. Stiglmayr C, Stecher-Mohr J, Wagner T, et al. Effectiveness of dialectic behavioral therapy in routine outpatient care: The Berlin Borderline Study. Bord Personal Disord Emot Dysregul. 2014;1(1):20. doi:10.1186/2051-6673-1-20
14. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry. 2015 May;72(5):475-82. doi:10.1001/jamapsychiatry.2014.3039
15. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour research and therapy. 2010;48(9):832–9. pmid:20579633
16. Zeifman RJ, Boritz T, Barnhart R, Labrish C, McMain SF. The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training. Personality Disorders: Theory, Research, and Treatment. 2019. pmid:31647267
17. Little H, Tickle A, das Nair R. Process and impact of dialectical behaviour therapy: A systematic review of perceptions of clients with a diagnosis of borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice. 2018;91(3):278–301.
18. Barnicot K, Couldrey L, Sandhu S, Priebe S. Overcoming barriers to skills training in borderline personality disorder: A qualitative interview study. PloS one. 2015;10(10). pmid:26465757
19. Hollon SD, Kendall PC. Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive therapy and research. 1980 Dec;4(4):383-95.
20. Kazdin AE. Evaluation of the Automatic Thoughts Questionnaire: Negative cognitive processes and depression among children. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Mar;2(1):73.
21. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the automatic thoughts questionnaire: ATQ-Persian. International Journal of Social Psychiatry. 2006; 52(2):127-137
22. Klonsky ED, Oltmanns TF, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry. 2003;160(8):1501-8. doi: 10.1176/appi.ajp.160.8.1501. [PubMed: 12900314]. [PubMed Central: PMC4362719].
23. Poorolajal J, Haghtalab T, Farhadi M, Darvishi N. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. J Public Health (Oxf). 2016;38(3):e282-91. doi: 10.1093/pubmed/fdv148.
24. Bildik T, Somer O, Kabukcu Basay B, Basay O, Ozbaran B. [The validity and reliability of the Turkish version of the inventory of statements about self-injury]. Turk Psikiyatri Derg. 2013;24(1):49-57.
25. Lindholm T, Bjarehed J, Lundh LG. Functions of nonsuicidal self-injury among young women in residential care: a pilot study with the Swedish version of the Inventory of Statements about Self-Injury. Cogn Behav Ther. 2011;40(3):183-9. doi: 10.1080/16506073.2011.565791.
26. Fox KR, Huang X, Guzmán EM, Funsch KM, Cha CB, Ribeiro JD, Franklin JC. Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological bulletin. 2020 Oct 29.
27. Rosenthal MZ, Cheavens JS, Lejuez CW, Lynch TR. Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms. Behaviour research and therapy. 2005 Sep 1;43(9):1173-85.
28. Afshari B, Omidi A, Ahmadvand A. Effects of dialectical behavior therapy on executive functions, emotion regulation, and mindfulness in bipolar disorder. Journal of Contemporary Psychotherapy. 2019 Oct 8:1-9.
29. Beck AT. Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of general psychiatry. 1963 Oct 1;9(4):324-33.
30. Beck AT. The current state of cognitive therapy: a 40-year retrospective. Archives of general psychiatry. 2005 Sep 1;62(9):953-9.
31. McCauley E, Berk MS, Asarnow JR, Adrian M, Cohen J, Korslund K, Avina C, Hughes J, Harned M, Gallop R, Linehan MM. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA psychiatry. 2018 Aug 1;75(8):777-85.
32. Elmaghraby R, Nobari O, Cullen KR. Treatment of non-suicidal self-injurious behavior in adolescents. Psychiatric Times. 2019 Nov;36(11):39-42.
33. Prada P, Perroud N, Rüfenacht E, Nicastro R. Strategies to deal with suicide and non-suicidal self-injury in borderline personality disorder, the case of DBT. Frontiers in psychology. 2018 Dec 17;9:2595.
Published
2021-10-03
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How to Cite
Treatment of Automatic Negative Thoughts and Non-suicidal Self-injury (NSSI) Behavior in Borderline Personality Disorder Adolescents: Dialectical Behavior Therapy. (2021). International Journal of Health Studies, 8(2), 31-35. https://doi.org/10.22100/ijhs.v8i2.900
