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Volume 15, Issue 3 (2023)
Iran J War Public Health 2023, 15(3): 271-278 |
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Received: 2023/08/6 | Accepted: 2023/09/10 | Published: 2023/09/19
Received: 2023/08/6 | Accepted: 2023/09/10 | Published: 2023/09/19
How to cite this article
Eyni S. Comparison of Different Therapies on Reducing Self-Injury Behaviors in PTSD Veterans. Iran J War Public Health 2023; 15 (3) :271-278
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S. Eyni *
Department of Psychology, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
Abstract (536 Views)
Aims: The present study was conducted to investigate the effectiveness of DBT-PE combined treatment protocol, dialectical behavior therapy, and prolonged exposure therapy in reducing self-injury behaviors of veterans with PTSD.
Materials & Methods: This experimental study was conducted with a pre-test/post-test design with a control group and a follow-up. The statistical population of the research was made up of all veterans with PTSD who were referred to Isar Psychiatric Hospital in Ardabil, Iran, in 2022. The research sample consisted of 80 veterans with PTSD, who were selected from the statistical population as a purposeful sampling, considering the acceptance of veterans to participate in the research in the first place and having the entry criteria. To collect data, the Inventory of Statements about Self-injury was used. The first experimental group received DBT (10 sessions of 90 minutes), the second experimental group received PE (10 sessions of 90 minutes), and the third experimental group received DBT-PE (16 sessions of 90 to 120 minutes).
Findings: All three intervention methods were effective in reducing self-injury behaviors of veterans with PTSD (p<0.01); However, the effect of combined treatment was greater than the other two interventions (p<0.05).
Conclusion: The combined treatment method has a greater effect in reducing self-injury behaviors in veterans with PTSD compared to prolonged exposure therapy and dialectical behavior therapy. Also, prolonged exposure therapy has a greater effect than dialectical behavior therapy.
Materials & Methods: This experimental study was conducted with a pre-test/post-test design with a control group and a follow-up. The statistical population of the research was made up of all veterans with PTSD who were referred to Isar Psychiatric Hospital in Ardabil, Iran, in 2022. The research sample consisted of 80 veterans with PTSD, who were selected from the statistical population as a purposeful sampling, considering the acceptance of veterans to participate in the research in the first place and having the entry criteria. To collect data, the Inventory of Statements about Self-injury was used. The first experimental group received DBT (10 sessions of 90 minutes), the second experimental group received PE (10 sessions of 90 minutes), and the third experimental group received DBT-PE (16 sessions of 90 to 120 minutes).
Findings: All three intervention methods were effective in reducing self-injury behaviors of veterans with PTSD (p<0.01); However, the effect of combined treatment was greater than the other two interventions (p<0.05).
Conclusion: The combined treatment method has a greater effect in reducing self-injury behaviors in veterans with PTSD compared to prolonged exposure therapy and dialectical behavior therapy. Also, prolonged exposure therapy has a greater effect than dialectical behavior therapy.
Keywords:
References
1. Sadeghi Z, Noghani F, Larigani TT, Ghafarzadeh M. The relationship between daily spiritual experiences and perceived stress with self-efficacy of wives of veterans suffering post-traumatic stress disorder in Golestan province. Health Spirituality Med Ethics. 2021;8(1):55-62. [Link]
2. Williams CL, Milanak ME, Judah MR, Berenbaum H. The association between PTSD and facial affect recognition. Psychiatry Res. 2018;265:298-302. [Link] [DOI:10.1016/j.psychres.2018.04.055]
3. American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™. 5th ed. Arlington: American Psychiatric Publishing Inc; 2013. [Link] [DOI:10.1176/appi.books.9780890425596]
4. Henkelmann JR, de Best S, Deckers C, Jensen K, Shahab M, Elzinga B, Molendijk M. Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis. BJPsych Open, 2020;6(4):e68. [Link] [DOI:10.1192/bjo.2020.54]
5. Basharpoor S, Einy S. The effectiveness of mentalization-based therapy on emotional dysregulation and impulsivity in veterans with post-traumatic stress disorder. Shefaye Khatam. 2020;8(3):10-9. [Persian] [Link] [DOI:10.29252/shefa.8.3.10]
6. Cassiello-Robbins C, Wilner JG, Peters JR, Bentley KH, Sauer-Zavala S. Elucidating the relationships between shame, anger, and self-destructive behaviors: The role of aversive responses to emotions. J Contextual Behav Sci. 2019;12:7-12. [Link] [DOI:10.1016/j.jcbs.2018.12.004]
7. Klonsky ED. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev. 2007;27(2): 226-39. [Link] [DOI:10.1016/j.cpr.2006.08.002]
8. Bryan CJ, Bryan AO, May AM, Klonsky ED. Trajectories of suicide ideation, nonsuicidal self-injury, and suicide attempts in a nonclinical sample of military personnel and veterans. Suicide Life Threat Behav. 2015;45(3):315-25. [Link] [DOI:10.1111/sltb.12127]
9. Dehghani Neyshabouri M, Dolatshahi B, Mohammadkhani P. PTSD symptoms and self-injury behaviors among Iranian soldiers: the mediator roles of rumination and social support. Cogent Psychology. 2020;7(1):1733333. [Link] [DOI:10.1080/23311908.2020.1733333]
10. Bergman BP, Mackay DF, Smith DJ, Pell JP. Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans. Soc Psychiatry Psychiatr Epidemiol. 2019;54(1):81-7. [Link] [DOI:10.1007/s00127-018-1588-9]
11. Meyers LL, Landes SJ, Thuras P. Veterans' service utilization and associated costs following participation in dialectical behavior therapy: A preliminary investigation. Mil Med. 2014;179(11):1368-73. [Link] [DOI:10.7205/MILMED-D-14-00248]
12. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757-66. [Link] [DOI:10.1001/archpsyc.63.7.757]
13. Muhomba M, Chugani, CD, Uliaszek AA, Kannan D. Distress tolerance skills for college students: A pilot investigation of a brief DBT group skills training program. J Coll Student Psychother. 2017;31(3):247-56. [Link] [DOI:10.1080/87568225.2017.1294469]
14. Goodman M, Banthin D, Blair N, Mascitelli K, Wilsnack J, Chen J, et al. A randomized trial of dialectical behavior therapy in high-risk suicidal veterans. J Clin Psychiatry. 2016;77(12):e1591-600. [Link] [DOI:10.4088/JCP.15m10235]
15. Decker SE, Adams L, Watkins LE, Sippel LM, Presnall-Shvorin J, Sofuoglu M, et al. Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: Pilot. Behav Cogn Psychother. 2019;47(5):616-21. [Link] [DOI:10.1017/S1352465819000122]
16. Johnstone OK, Marshall JJ, McIntosh LG. A review comparing dialectical behavior therapy and mentalization for adolescents with borderline personality traits, suicide and self-harming behavior. Adolescent Res Rev. 2022;7:187-209. [Link] [DOI:10.1007/s40894-020-00147-w]
17. Wu SI, Huang HC, Chen JSC, Korslund K, Lin CJ, Lin Y, et al. Dialectical behavior therapy in suicidal patients with borderline personality disorder: A pilot randomized controlled trial in Taiwan. Asia Pac Psychiatry. 2023;15(2-3):e12541. [Link] [DOI:10.1111/appy.12541]
18. Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther. 2014;55:7-17. [Link] [DOI:10.1016/j.brat.2014.01.008]
19. Foa EB, Hembree EA, Rothbaum BO, Rauch SAM. Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. 2nd ed. Oxford: Oxford University Press; 2019. [Link] [DOI:10.1093/med-psych/9780190926939.001.0001]
20. Foa EB, Hembree E, Rothbaum BO. Prolonged exposure therapy for ptsd: emotional processing of traumatic experiences, therapist guide. 1 Ed. Oxford: Oxford University Press; 2007. p. 10-55. [Link] [DOI:10.1093/med:psych/9780195308501.003.0001]
21. Brown LA, Belli G, Suzuki N, Capaldi S, Foa EB. Reduction in suicidal ideation from prolonged exposure therapy for adolescents. Journal of Clinical Child & Adolescent Psychology, 2019, 49(5), 651-659. [Link] [DOI:10.1080/15374416.2019.1614003]
22. Brown LA, Belli GM, Asnaani A, Foa EB. A review of the role of negative cognitions about oneself, others, and the world in the treatment of PTSD. Cogn Ther Res. 2019;43(1):143-73. [Link] [DOI:10.1007/s10608-018-9938-1]
23. Burback L, Dhaliwal R, Reeson M, Erick T, Hartle K, Chow E, et al. Trauma focused psychotherapy in patients with suicidal ideation: A scoping review. Curr Res Behav Sci. 2023;4:100102. [Link] [DOI:10.1016/j.crbeha.2023.100102]
24. Shiner B, D'Avolio LW, Nguyen TM, Zayed MH, Young-Xu Y, Desai RA, et al. Measuring use of evidence based psychotherapy for posttraumatic stress disorder. Adm Policy Ment Health. 2013;40(4):311-8. [Link] [DOI:10.1007/s10488-012-0421-0]
25. Landes SJ, Garovoy ND, Burkman KM. Treating complex trauma among veterans: Three stage-based treatment models. J Clin Psychol. 2013;69(5):523-33. [Link] [DOI:10.1002/jclp.21988]
26. Frye LA, Spates CR. Prolonged exposure, mindfulness, and emotion regulation for the treatment of PTSD. Clin Case Stud. 2012;11:184-200. [Link] [DOI:10.1177/1534650112446850]
27. Harned MS, Linehan MM. Integrating dialectical behavior therapy and prolonged exposure to treat co-occurring borderline personality disorder and PTSD: Two case studies. Cognitive Behav Practice. 2008;15:263-76. [Link] [DOI:10.1016/j.cbpra.2007.08.006]
28. Wagner AW, Rizvi SL, Harned MS. Applications of dialectical behavior therapy to the treatment of complex trauma-related problems: When one case formulation does not fit all. J Trauma Stress. 2007;20(4):391-400. [Link] [DOI:10.1002/jts.20268]
29. Harned M, Schmidt S, Korslund K, Gallop R. Does adding the dialectical behavior therapy prolonged exposure (DBT PE) protocol for PTSD to DBT improve outcomes in public mental health settings? A pilot nonrandomized effectiveness trial with benchmarking. Behav Ther. 2021;52(3):639-55. [Link] [DOI:10.1016/j.beth.2020.08.003]
30. Mugambi P. Efficacy of dialectical behavior and prolonged exposure therapy in treating suicidal behavior among adolescents with posttraumatic stress and depressive disorders in Nairobi, Kenya [dissertation]. Athi River: Daystar University; 2020. [Link]
31. Delavar A. Research Methods in Psychology and Educational Sciences. Tehran: Virayesh Publishing.; 2017. [Persian] [Link]
32. First MB, Williams JBW, Karg RS, Spitzer RL. Structured Clinical Interview for DSM-5® Disorders-Clinician Version (SCID-5-CV). Washington: American Psychiatric Association; 2016. [Link]
33. Sharifi V, Asadi S M, Mohammadi M R, Amini H, Kaviani H, Semnani Y, et al. Reliability and Feasibility of The Persian Version of The Structured Diagnostic Interview for DSM-IV (SCID). Adv Cognitive Sci. 2004;6(1-2):10-22. [Persian] [Link]
34. Klonsky ED, Glenn CR. Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements about Self-injury (ISAS). J Psychopathol Behav Assess. 2009;31(3):215-19. [Link] [DOI:10.1007/s10862-008-9107-z]
35. Saffarinia M, Nikoogoftar M, Damavandian A. The effectiveness of Dialectical Behavior Therapy (DBT) on reducing self-harming behaviors in juvenile offenders in Tehran's Juvenile correction and rehabilitation centre. Clin Psychol Stud. 2015;4(15):141-58. [Persian] [Link]
36. Bisson JI, Berliner L, Cloitre M, Forbes D, Jensen TK, Lewis C, et al. The international society for traumatic stress studies new guidelines for the prevention and treatment of PTSD: Methodology and development process. J Trauma Stress. 2019;32(4):475-83. [Link] [DOI:10.1002/jts.22421]
37. DeCou CR, Comtois KA, Landes SJ. Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behav Ther. 2019;50(1):60-72. [Link] [DOI:10.1016/j.beth.2018.03.009]
38. Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Sys Rev. 2020;5(5):CD012955. [Link] [DOI:10.1002/14651858.CD012955.pub2]
39. Meyers L, Voller EK, McCallum EB, Thuras P, Shallcross S, Ve- lasquez T, et al. Treating veterans with PTSD and border-line personality symptoms in a 12-week intensive outpatient setting: Findings from a pilot program. J Trauma Stress. 2017;30(2):178-81. [Link] [DOI:10.1002/jts.22174]