Dialectical behavior therapy in an intensive outpatient program with a mixed-diagnostic sample.

OBJECTIVES: Intensive outpatient programs (IOPs) have become increasingly common for treating highly distressed patients, and a burgeoning number of IOPs are based on, or informed by, dialectical behavior therapy (DBT). The goal of the present study was to evaluate the effectiveness of DBT in a community mental health center IOP for patients with heterogeneous diagnoses. METHOD: Using a within-subjects design, we examined changes in depression, anxiety, mindfulness, and hope during DBT treatment in a community mental health center in the Midwestern United States. The final sample comprised 56 participants (59% female) ranging in age from 18 to 73 years, with a mean age of 36.8 years (standard deviation = 13.7). The majority of participants (80%) met criteria for a mood disorder, just over half met criteria for an anxiety disorder, and 20% met criteria for comorbid substance abuse or dependence. Over half met criteria for more than one diagnosis. Length of treatment varied based on the needs of the individual patient; treatment ranged from 2 to 16 weeks, with an average stay of 6 weeks. RESULTS: Depression and anxiety scores decreased significantly and hope scores increased significantly over the course of treatment (all p's < .001). Mindfulness scores did not increase significantly, although changes did occur in the predicted direction. In addition, the extent to which hope and mindfulness increased over the course of treatment predicted final depression and anxiety scores after controlling for baseline symptom levels. CONCLUSIONS: Results suggest that this DBT-informed intervention was effective in reducing depression and anxiety and increasing hope. Because of the move away from inpatient hospitalizations over the last few decades, it is incumbent on the field to find alternative ways to treat patients in need of more acute, intensive care. Moreover, these treatments must be cost effective, as many of these patients have limited financial resources. Group therapy formats might provide an appropriate and needed bridge for this coverage gap. The results of this study suggest that a DBT-informed IOP might be an amenable treatment for this population.

Effectiveness of a brief dialectical behavior therapy intensive-outpatient community health program.

Standard dialectical behavior therapy (DBT), with its 12-month format, has a documented record of efficacy. While emerging evidence is supportive of DBT adaptations in community mental health settings and brief, intensive formats, many of these studies are limited by sample size of its DBT group, by omission of program completion rates and specific data from program noncompleters, and by focusing solely on symptom-focused measures-which inadvertently omits observing gains associated with well-being. We used a nonexperimental design to assess client outcomes on pathology-focused and positive-psychology measures in a brief DBT intensive-outpatient Community Mental Health Center in the midwestern United States for program graduates and program dropouts who completed at least two surveys (n = 77). This is the shortest average program length (M = 19.01 days) known for a DBT program. Scores on measures of depression (d = 0.41), anxiety (d = 0.5), stress (d = 0.5), and difficulties in emotion regulation (d = 0.51) all decreased from entrance to exit. Scores on measures of mindfulness (d = 0.43), Snyder's hope (d = 0.51), and integrative hope (d = 0.41) increased from entrance to exit. These results provide evidence that pathology decreases and measures associated with well-being increase in this brief, intensive-outpatient community health DBT program. This study provides support for future investigations of brief, intensive community health programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the psychometric properties of the Integrative Hope Scale's English translation in a mixed-diagnostic community health sample.

OBJECTIVE: Our objective is to provide preliminary evidence of the English translation of the Integrative Hope Scale (IHS). Hope is a critical concept for recovery. Synthesizing from other hope models, Schrank and colleagues developed the IHS. Although translated into five languages, no known studies assess the IHS's English translation within a clinical sample. Additionally, no known studies investigate the IHS's relationships with mental health measures in a mixed-diagnostic clinical sample. METHOD: To address these gaps in the literature, we used confirmatory factor analyses, alpha, and omega reliability coefficients, and correlational analyses to assess the IHS within a suburban, mixed-diagnostic intensive outpatient community mental health sample (n = 125) in the midwestern United States. RESULTS: While poorest fit was found within the one-factor model, the four-factor oblique, higher-order, and bifactor models showed improved fit. Reliability for the total score was good, with subscales ranging from acceptable to good. Significant relationships were found for the IHS in expected directions with measures of hope and depression at a large effect size and anxiety and stress at a moderate effect size. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study provides preliminary evidence that the IHS may have the potential to serve as a central measure of hope. Given hope's role within recovery and given its relationships with mental health measures shown in this mixed-diagnostic clinical sample, the IHS should continue to be investigated by researchers, clinicians, and clients, especially in recovery-focused programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).