DBT-SS for Cognitively Challenged Individuals With Deliberate Self-harm
Condition: Self Harm; Suicide, Attempted; Borderline Personality Disorder
MeSH terms: Self Mutilation; Suicide; Personality Disorders; Borderline Personality Disorder; Self-Injurious Behavior; Suicide, Attempted
Study type: Interventional

Summary: 
      The study evaluates the effect of Dialectic Behavior Therapy Skills System (DBT-SS) in
      individuals with Intelligence Quotient 65-85 and recurrent self-harm. The study is primarily
      descriptive with 6 cases followed by repeated measurements (weekly; time series analysis).
      Primary outcome measure is frequency and severity of self-harming behavior, reported weekly 4
      weeks before the start of the intervention, throughout the intervention and 12 weeks after
      the intervention has stopped.
    

Detailed description: 
      Not many psychotherapies are adapted to suit individuals with Intelligence Quotient(IQ) in
      the lower normal range. For individuals diagnosed with cognitive disability and self-harm,
      psychiatric treatment as usual often consists of only supportive meetings and sometimes heavy
      medication.

      Dialectical Behavior therapy (DBT) is one of the evidence based treatments for individuals
      with self-harm and Borderline Personality Disorder. It is a comprehensive, multi component
      treatment, usually lasting a year or more. When offering DBT to individuals with cognitive
      disabilities or IQ in the lower normal range, it is necessary to alter the individual therapy
      procedures and skills group materials, while remaining adherent to DBT principles.

      The Skills System is an adaptation of the standard DBT skills for individuals with cognitive
      challenges, well suited for IQ 65-85. When adapted DBT individual therapy integrates the
      Skills System as the skill group curriculum the treatment is called DBT-Skills System
      (DBT-SS). DBT-SS comprises weekly individual sessions, weekly group education and separate
      education for caregivers and/or near standing persons. The method is tested with positive
      effects on problem behaviors, however results need to be reproduced, and further tested in a
      randomized controlled trial. The handouts from Skills System has recently been translated to
      Swedish.

      The current study aims to investigate the effect of Skills system on individuals with
      self-harm, IQ 65-85 and three or more symptoms of borderline personality disorder. A
      single-case time series design will be used with repeated, weekly measurements before, during
      and after the intervention is provided. 6 participants will be recruited in a pilot study, to
      investigate the feasibility of the method in a Swedish setting. Main outcome measures are
      frequency and severity of self-harming and aggressive behaviors, number of days with hospital
      admission and coercive care, number of medications, and self-rated level of daily
      functioning. Participation will last 64-70 weeks depending on when the group therapy starts
      in relation to enrollment.
    

Intervention name(s): Dialectic Behavior Therapy - Skills System
Intervention type(s): Behavioral
Intervention description(s): Treatment with Dialectical Behavior therapy adapted for cognitively challenged individuals
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment