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Emotion regulation group therapy for deliberate self-harm : A multi-site evaluation in routine care using an uncontrolled open trial design

Sahlin, Hanna; Bjureberg, Johan; Gratz, Kim L.; Tull, Matthew T.; Hedman, Erik; Bjärehed, Jonas LU ; Jokinen, Jussi; Lundh, Lars Gunnar LU ; Ljótsson, Brjánn and Hellner Gumpert, Clara (2017) In BMJ Open 7(10).
Abstract

Objective Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset. Design Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up. Setting 14 adult outpatient psychiatric clinics across Sweden. Participants Ninety-five women... (More)

Objective Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset. Design Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up. Setting 14 adult outpatient psychiatric clinics across Sweden. Participants Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment. Primary and secondary outcome measures Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties. Intervention ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation. Results At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up. Conclusions ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community. Trial registration number NCT01986257; results.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
borderline personality disorder, emotion regulation, group therapy, implementation
in
BMJ Open
volume
7
issue
10
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85031115619
ISSN
2044-6055
DOI
10.1136/bmjopen-2017-016220
language
English
LU publication?
yes
id
33c57e12-69af-4451-846a-6394c8c563b4
date added to LUP
2017-11-03 10:11:36
date last changed
2018-02-03 03:00:07
@article{33c57e12-69af-4451-846a-6394c8c563b4,
  abstract     = {<p>Objective Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset. Design Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up. Setting 14 adult outpatient psychiatric clinics across Sweden. Participants Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment. Primary and secondary outcome measures Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties. Intervention ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation. Results At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p&lt;0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up. Conclusions ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community. Trial registration number NCT01986257; results.</p>},
  articleno    = {e016220},
  author       = {Sahlin, Hanna and Bjureberg, Johan and Gratz, Kim L. and Tull, Matthew T. and Hedman, Erik and Bjärehed, Jonas and Jokinen, Jussi and Lundh, Lars Gunnar and Ljótsson, Brjánn and Hellner Gumpert, Clara},
  issn         = {2044-6055},
  keyword      = {borderline personality disorder,emotion regulation,group therapy,implementation},
  language     = {eng},
  month        = {10},
  number       = {10},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {Emotion regulation group therapy for deliberate self-harm : A multi-site evaluation in routine care using an uncontrolled open trial design},
  url          = {http://dx.doi.org/10.1136/bmjopen-2017-016220},
  volume       = {7},
  year         = {2017},
}