Effectiveness of dialectical behavior therapy-online group skills training during the pandemic: A pilot study

Yıl 2023, , 41 - 59, 02.05.2023

Hüdanur Akkuzu Ayşe Beyza İnce Çolak Gülşen Karaman Özlem Yılmaz , Setenay Koç Tuğba Öz F. Işıl Bilican

https://doi.org/10.57127/kpd.26024438m000079X1

Öz

Dialectical Behavior Therapy (DBT) was developed by Linehan for clients with borderline personality disorder. It is based on behaviorist approach, Zen Buddhism, and dialectical philosophy. There are four components: individual session, group skills training, telephone coaching, and consultation team. DBT group skill training consists of four modules in total, including mindfulness, interpersonal effectiveness, stress tolerance, and emotion regulation skills. Many studies have been conducted on the effectiveness of DBT and DBT group skills training. In this study, the effectiveness of 8-week DBT group skill training in university students on depression, anxiety, and stress levels during the pandemic was investigated. In addition, the improvements in emotion regulation, mindfulness, and interpersonal effectiveness skills were observed. A total of 17 women, who were undergraduate students between the ages of 18-24, participated in the study. An online self-evaluation form was sent to the participants and feedback was given to the applicants by phone call. Sociodemographic Information Form, the Five Facet Mindfulness Questionnaire-Short Form, Difficulties in Emotion Regulation Scale-Brief Form, Interpersonal Competence Questionnaire-Short Form, and Depression Anxiety Stress Scale were sent online to the selected participants before participating in the group skill training, after the 4th session, and at the end of the 8th week. According to the results, DBT group skill training was found to be helpful in reducing depression, anxiety, and stress levels. In addition, an increase was observed in emotion regulation and interpersonal competence skills.

Anahtar Kelimeler

dialectical behavior therapy, anxiety, depression, stress, pandemic, therapy effectiveness

Pandemi döneminde diyalektik davranış terapisi-çevimiçi grup beceri eğitimi etkililiği: Pilot bir çalışma

Öz

Diyalektik Davranış Terapisi (DDT), Linehan tarafından sınırda kişilik bozukluğu danışanlar için geliştirilmiştir. Temelinde davranışçı yaklaşım, Zen Budizmi ve diyalektik felsefe bulunmaktadır. Bireysel seans, grup beceri eğitimi, telefonla danışmanlık ve konsültasyon ekibi olmak üzere dört bileşen vardır. DDT grup beceri eğitimi de bilinçli farkındalık, kişilerarası etkililik, sıkıntıya dayanma ve duygu düzenleme becerileri olmak üzere toplamda dört modülden oluşmaktadır. DDT’nin ve DDT grup beceri eğitiminin etkililiğine dair birçok çalışma yürütülmüştür. Bu çalışmada ise haftalık DDT grup beceri eğitiminin üniversite öğrencilerinde pandemi dönemindeki depresyon, kaygı ve stres düzeylerindeki etkililiği incelenmiştir. Ayrıca katılımcılarda duygu düzenleme, bilinçli farkındalık, kişilerarası etkililik becerilerindeki gelişmeler de gözlenmiştir. Çalışmaya 18-24 yaş arasında lisans öğrencisi olan toplamda 17 kadın katılmıştır. Katılımcılara çevrimiçi öz değerlendirme formu gönderilmiş ve telefon görüşmesi ile başvuruda bulunanlara geri bildirim yapılmıştır. Seçilen katılımcılara Sosyodemografik Bilgi Formu, Beş Faktörlü Bilgece Farkındalık Ölçeği-Kısa Form, Duygu Düzenleme Güçlüğü Ölçeği-Kısa Form, Kişilerarası Yetkinlik Ölçeği-Kısa Formu, Depresyon Kaygı Stres Ölçeği, grup beceri eğitimine katılmadan önce, 4. oturumdan sonra ve 8. haftanın sonunda çevrimiçi olarak gönderilmiştir. Sonuçlara göre, DDT grup beceri eğitiminin depresyon, kaygı ve stres düzeylerinin azalmasında yardımcı olduğu saptanmıştır. Ayrıca, duygu düzenleme ve kişilerarası etkililik becerilerinde de artış gözlenmiştir.

Anahtar Kelimeler

diyalektik davranış terapisi, kaygı, depresyon, stres, pandemi, terapi etkililiği

Kaynakça

• Accardo, M. S. (2020). DBT interpersonal effectiveness skills as social anxiety intervention in college students. Hofstra University.
• Afshari, B. ve Hasani, J. (2020). Study of dialectical behavior therapy versus cognitive behavior therapy on emotion regulation and mindfulness in patients with generalized anxiety disorder. Journal of Contemporary Psychotherapy, 50, 305-312.
• Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W. ve Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176-181.
• Ayalp, H. D. ve Hisli Şahin, N. (2018). Beş Faktörlü Bilgece Farkındalık Ölçeği-Kısa Formu’nun (BFBFÖ-K) Türkçe uyarlaması. Klinik Psikoloji Dergisi, 2(3), 117-127.
• Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J. ve Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27-45.
• Beanlands, H., McCay, E., Fredericks, S., Newman, K., Rose, D., Santa Mina, E., Schindel Martin, L., Schwind, J., Sidani, S., Aiello, A. ve Wang, A. (2019). Decreasing stress and supporting emotional well-being among senior nursing students: A pilot test of an evidence-based intervention. Nurse Education Today, 76, 222-227.
• Berk, L., Hotterbeekx, R., van Os, J. ve van Boxtel, M. (2017). Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: A mixed-methods study. Aging & Mental Health, 1-8.
• Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L.-G, Bjärehed, J., DiLillo, D., Messman-Moore, T., Gumpert, C. H. ve Gratz, K. L. (2016). Development and validation of a brief version of the Difficulties in Emotion Regulation Scale: The DERS-16. Journal of Psychopathology and Behavioral Assessment, 38(2), 284-296.
• Buhrmester, D., Furman, W., Wittenberg, W. T. ve Reis, H.T. (1988). Five domains of interpersonal competence in peer relationships. Journal of Personality and Social Psychology, 55(6), 991-1008.
• Choudhary, S. ve Thapa, K. (2012). Dialectical behavior therapy for managing interpersonal relationships. Psychological Studies, 57(1), 46-54.
• Chugani, C. D., Ghali, M. N. ve Brunner, J. (2013). Effectiveness of short term dialectical behavior therapy skills training in college students with cluster B personality disorders. Journal of College Student Psychotherapy, 27(4), 323-336.
• Coiro, M. J., Bettis, A. H. ve Compas, B. E. (2016). College students coping with interpersonal stress: Examining a control-based model of coping. Journal of American College Health, 65(3), 177-186.
• Del Conte, G., Lenz, A. S. ve Hollenbaugh, K. M. (2016). A pilot evaluation of dialectical behavior therapy for adolescents within a partial hospitalization treatment milieu. Journal of Child and Adolescent Counseling, 2(1), 1632.
• Dimeff, L. A. ve Koerner, K. E. (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. Guilford Press.
• Eftekhari, A., Zoellner, L. A. ve Vigil, S. A. (2009). Patterns of emotion regulation and psychopathology. Anxiety, Stress & Coping, 22(5), 571-586.
• Feijt, M., de Kort, Y., Bongers, I., Bierbooms, J., Westerink, J. ve IJsselsteijn, W. (2020). Mental health care goes online: Practitioners' experiences of providing mental health care during the COVID-19 pandemic. Cyberpsychology, Behavior, and Social Networking, 23(12), 860-864.
• Fitzpatrick, S., Bailey, K. ve Rizvi, S. L. (2019). Changes in emotions over the course of dialectical behavior therapy and the moderating role of depression, anxiety, and Posttraumatic Stress Disorder. Behavior Therapy, 51(6), 946-957.
• Fruzzetti, A. E. ve Levensky, E. R. (2000). Dialectical behavior therapy for domestic violence: Rationale and procedures. Cognitive and Behavioral Practice, 7(4), 435-447.
• Gratz, K. L. ve Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.
• Haliwa, I., Spalding, R., Smith, K., Chappell, A. ve Strough, J. (2021). Risk and protective factors for college students’ psychological health during the COVID-19 pandemic. Journal of American College Health, 1-5.
• Hollenbaugh, K. M. H. ve Lenz, A. S. (2018). Preliminary evidence for the effectiveness of Dialectical Behavior Therapy for adolescents. Journal of Counseling & Development, 96(2), 119-131.
• Kazemi, A., Peyman, A. ve Salehi, A. (2020). The effectiveness of teaching emotion regulation based on dialectical behavioral therapy on reduce students' anxiety and anger. Armaghane Danesh, 25(4), 451-465.
• Kia, M. N., Rasouli, M. ve Bahramabadi, M. Z. (2020). Effectiveness of Dialectical Behavioral Group Therapy on rumination and emotional regulation strategies in patients with generalized anxiety disorder. Psychotherapy, (9), 69-83.
• Lee, S. ve Mason, M. (2018). Effectiveness of Brief DBT-informed Group Therapy on psychological resilience: A preliminary naturalistic study. Journal of College Student Psychotherapy, 1-13.
• Lin, T. J., Ko, H. C., Wu, J. Y. W., Oei, T. P., Lane, H. Y. ve Chen, C. H. (2019). 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, 23(1), 82-99.
• Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. The Guilford Press.
• Linehan, M. M. (2015). DBT skills training manual (2. baskı). The Guilford Press.
• Lovibond, P. F. ve Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335-343.
• Marra, T. (2005). Dialectical behavior therapy in private practice: A practical & comprehensive guide. New Harbinger Publications.
• Martin, C. G., Roos, L. E., Zalewski, M. ve Cummins, N. (2017). A dialectical behavior therapy skills group case study on mothers with severe emotion dysregulation. Cognitive and Behavioral Practice, 24(4), 405-415.
• Mitchell, R., Roberts, R., Bartsch, D., & Sullivan, T. (2019). Changes in mindfulness facets in a dialectical behaviour therapy skills training group program for borderline personality disorder. Journal of Clinical Psychology, 75, 958-969.
• Neacsiu, A. D., Bohus, M. ve Linehan, M. M. (2014). Dialectical behavior therapy: An intervention for emotion dysregulation J. J. Gross (Ed.), Handbook of emotion regulation içinde (s. 491-507). The Guilford Press.
• Pepping, C. A., O’Donovan, A., Zimmer-Gembeck, M. J. ve Hanisch, M. (2014). Is emotion regulation the process underlying the relationship between low mindfulness and psychosocial distress? Australian Journal of Psychology, 66(2), 130-138.
• Rizvi, S. L. ve Steffel, L. M. (2014). A pilot study of 2 brief forms of dialectical behavior therapy skills training for emotion dysregulation in college students. Journal of American College Health, 62(6), 434-439.
• Sarıçam, H. (2018). The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive-Behavioral Psychotherapy and Research, 7(1), 19-30.
• Şahin, E. E. ve Gizir, C. A. (2013). Kişilerarası Yetkinlik Ölçeği-Kısa Formu: Geçerlik ve güvenirlik çalışmaları. Mersin Üniversitesi Eğitim Fakültesi Dergisi, 9(3), 144-158.
• Tran, U. S., Glück, T. M. ve Nader, I. W. (2013). Investigating the Five Facet Mindfulness Questionnaire (FFMQ): Construction of a short form and evidence of a two-factor higher order structure of mindfulness. Journal of Clinical Psychology, 69(9), 951-965.
• Üstündağ-Budak, A. M., Özeke-Kocabaş, E. ve Ivanoff, A. (2019). Dialectical behaviour therapy skills training to improve Turkish college students’ psychological well-being: A pilot feasibility study. International Journal for the Advancement of Counseling, 41, 580-597.
• Wilks, C. R., Valenstein-Mah, H., Tran, H., King, A. M. M., Lungu, A. ve Linehan, M. M. (2017). Dialectical behavior therapy skills for families of individuals with behavioral disorders: Initial feasibility and outcomes. Cognitive and Behavioral Practice, 24(3), 288-295.
• Wind, T. R., Rijkeboer, M., Andersson, G. ve Riper, H. (2020). The COVID-19 pandemic: The ‘black swan’for mental health care and a turning point for e-health. Internet Interventions, 20, 100317.
• Yiğit, İ. ve Guzey Yiğit, M. (2019). Psychometric properties of Turkish version of Difficulties in Emotion Regulation Scale-Brief Form (DERS-16). Current Psychology, 38, 1503-1511.
• Zeifman, R. J., Boritz, T., Barnhart, R., Labrish, C. ve McMain, S. F. (2020). The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training. Personality Disorders: Theory, Research, and Treatment, 11(3), 181-190.