Commitment and Motivation in a Brief DBT Intervention for Self Harm
Condition: Psychological Orientation; Acceptance Processes
MeSH terms: Self-Injurious Behavior
Study type: Interventional

Summary: 
      Research suggests that individuals with Borderline Personality Disorder (BPD) experience low
      motivation for change (Skodal, Buckley, & Charles, 1983). Dialectical Behavior Therapy (DBT;
      Linehan, 1993) includes commitment strategies that are designed to improve motivation. No
      studies have examined the effectiveness of these strategies. The proposed study will evaluate
      the efficacy of a brief DBT intervention consisting of commitment strategies plus skills
      training for people who self-harm. Participants will be randomly assigned to either a single
      orientation session of (1) commitment strategies plus psychoeducation or (2) psychoeducation.
      Immediately following their orientation session, all participants will be enrolled in a 90
      minute group skills training session. Primary outcomes include autonomous motivation and
      frequency of self harm behaviours. Assessments will be conducted at six time points:
      baseline, after the initial orientation session, after the skills training group session, and
      at one week, one month, and three month follow-up
    

Detailed description: 
      Client motivation is related to therapeutic change (Ryan, Lynch, Vansteenkiste, & Deci) and
      low motivation is a pervasive issue for clients with BPD (e.g., Skodal et al., 1983). DBT
      (Linehan, 1993) is an effective treatment for BPD and was developed in part to address client
      motivation. Within DBT there are commitment strategies that are used to help clients
      establish clear goals and increase motivation to work on them. These strategies were designed
      to help people commit to eliminating self-harm as well as other behaviours. People are more
      motivated to work effectively towards goals for which they are autonomously motivated (Deci &
      Ryan, 2000). Despite their importance in DBT, commitment strategies have never been studied.
      This study will examine whether commitment strategies are associated with an increase in
      autonomous motivation and a decrease in self harm behaviour.

      This research will address two primary questions: 1) Are commitment strategies associated
      with an increase in autonomous motivation to decrease self-harm behaviour?; and 2) Does
      autonomous motivation mediate a relationship between commitment strategies and change in
      self-harm behaviour? The investigators will also address a secondary question related to
      predictors of autonomous motivation. Our hypotheses are as follows: 1) The group receiving
      psychoeducation enhanced with commitment strategies will have higher levels of autonomous
      motivation compared to the psychoeducation control group; and 2) autonomous motivation will
      mediate the relationship between commitment strategies and decreases in self harm behaviour.
      Additionally, autonomy support, low therapist judgment, and goal concordance between client
      and therapist will independently contribute to predicting client autonomous motivation.

      Research in this area is needed in light of the challenges presented by the low motivation
      that often characterizes individuals with borderline traits who engage in self-harm
      behaviour. No studies to date have examined DBT's commitment strategies, thus, the effect of
      these treatment strategies is unknown and needs to be established. Additionally, identifying
      specific variables that are associated with motivation to eliminate self-harm will help
      inform the refinement treatment strategies. Finally, few studies have examined the role of
      autonomous motivation and treatment outcome.
    

Intervention name(s): DBT Skills Training
Intervention type(s): Behavioral
Intervention description(s): Based on Linehan's (1993) manualized DBT approach, the brief DBT skills training group covers will cover five skills: wise mind, TIP skills, distraction, mindfulness of the current emotion, and opposite to emotion action.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Commitment strategies; Motivation; DBT skills; Self-harm; Brief intervention