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Practice-based Outcomes of Dialectical Behavior Therapy (DBT) Targeting Anger and Violence, with Male Forensic Patients: A Pragmatic and Non-Contemporaneous Comparison

NCJ Number
Criminal Behaviour and Mental Health Volume: 13 Issue: 3 Dated: 2003 Pages: 198-213
Sue Evershed; Allison Tennant; Debbie Boomer; Anne Rees; Michael Barkham; Alison Watson
Date Published
16 pages
This study examined the effectiveness of an 18-month treatment program that used dialectical behavior therapy (DBT), which targeted anger and violence for a group of male forensic patients.
DBT was developed by Linehan (1993) by using a model of borderline personality disorder, which is characterized by a lack of skills in mindfulness, interpersonal regulation, emotion regulation, and distress tolerance. Personal and environmental factors inhibit the use of adaptive skills and reinforce maladaptive skills. DBT therapy combines weekly group skills training with individual behavioral psychotherapy. Treatment is structured and hierarchical, targeting the most problematic behavior. Overall, DBT blends validation and acceptance strategies with change-focused cognitive-behavioral therapy, including problem solving, contingency management, cognitive modification, exposure procedures, and skills training. In the current study, eight male forensic patients with diagnosed borderline personality disorder were enrolled in the DBT group to receive treatment for violent behavior, ideation, urges, and anger, along with parasuicidal and therapy-interfering behavior. The men completed three psychometric tests at pretreatment, midtreatment, posttreatment, and at a 6-month follow-up. A comparison group (TAU) of nine patients, who were also diagnosed with similar personality disorders, received the usual treatment available in the hospital, but excluding DBT. They received the same testing as the DBT patients. For both groups, all instances of behaviors that involved anger and violence were monitored for three 6-month periods prior to, during, and after treatment. Overall, patients in the DBT group made greater gains than patients in the TAU group regarding reduction in the seriousness of violence-related incidents and in self-report measures of hostility, cognitive anger, disposition to anger, outward expression of anger, and anger experience. The study concluded that DBT has promising potential for achieving positive change in violent behavior and components of anger in male forensic patients. 4 tables and 55 references