Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations

Journal of Clinical Psychology

Volumn 62, Issue 4, 2006, Pages 459-480

  Lynch, Thomas R ^a   Chapman, Alexander L ^b,c   Rosenthal, M Zachary ^a   Kuo, Janice R ^b   Linehan, Marsha M ^b  

^a DUKE UNIVERSITY MEDICAL CENTER   (United States)

^b UNIVERSITY OF WASHINGTON   (United States)

^c SIMON FRASER UNIVERSITY   (Canada)

Author keywords

Borderline personality disorder; Dialectical behavior therapy; Exposure therapy; Mechanisms of change; Mindfulness

Indexed keywords

ATTENTION; BEHAVIOR THERAPY; BORDERLINE STATE; CLINICAL PRACTICE; CLINICAL RESEARCH; COGNITION; EMOTION; EMOTIONAL DISORDER; EXPERIENCE; HUMAN; MEMORY; PATIENT ATTITUDE; PATIENT COMPLIANCE; PHILOSOPHY; PSYCHOANALYSIS; REVIEW; TELECONSULTATION;

AFFECT; APPETITIVE BEHAVIOR; BEHAVIOR THERAPY; BORDERLINE PERSONALITY DISORDER; COGNITION; DEFENSE MECHANISMS; EMPIRICAL RESEARCH; HUMANS; PSYCHOLOGICAL THEORY;

EID: 33645974033     PISSN: 00219762     EISSN: 10974679     Source Type: Journal    
DOI: 10.1002/jclp.20243     Document Type: Review

References (101)

1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2. Baer, R.A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science & Practice, 10, 125-143.
3. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
4. Bandura, M., & Goldman, C. (1995). Expanding the contextual analysis of clinical problems. Cognitive and Behavioral Practice, 2, 119-141.
5. Barlow, D. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford Press.
6. Baron, R., & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality & Social Psychology, 51, 1173-1182.
7. Basseches, M. (1984). Dialectical thinking and adult development. Norwood, NJ: Ablex.
8. Bijttebier, P., & Vertommen, H. (1999). Coping strategies in relation to personality disorders. Personality and Individual Differences, 26, 847-856.
9. Bohus, M., Haaf, B., Stiglmayr, C., Pohl, U., Bohme, R., & Linehan, M. (2000). Evaluation of inpatient dialectical behavior therapy for borderline personality disorder - a prospective study. Behaviour Research and Therapy, 38, 875-887.
10. Bopp, M., & Weeks, G. (1984). Dialectical metatheory in family therapy. Family Process, 23, 49-61.
11. Borkovec, T., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611-619.
12. Bouton, M. (1993). Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. Psychological Bulletin, 114, 80-99.
13. Bouton, M. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52, 976-986.
14. Bouton, M., & Brooks, D. (1993). Time and context effects on performance in a Pavlovian discrimination. Journal of Experimental Psychology: Animal Behavior Processes, 19, 165-179.
15. Burns, D.D., & Spangler, D.L. (2001). Do changes in dysfunctional attitudes mediate changes in depression and anxiety disorders? Behavior Therapy, 32, 337-369.
16. Chambless, D.L., & Hollon, S.D. (1998). Defining empirically supported therapies. Journal of Consulting & Clinical Psychology, 66, 7-18.
17. Chapman, A.L., & Linehan, M.M. (2005). Dialectical behavior therapy for borderline personality disorder. In M. Zanarini (Ed.), Borderline personality disorder (pp. 211-242). Florida: Taylor & Francis.
18. Cheavens, J.S., Rosenthal, M.Z., Daughters, S.D., Novak, J., Kossen, D., Lynch, T.R., et al. (2005). Understanding the relationships among perceived parental criticism, negative affect, and borderline personality disorder symptoms: The role of thought suppression. Behavior Research and Therapy, 43, 257-268.
19. Comtois, K.A., Elwood, L.M., Holdcraft, L.C., & Simpson, T.L. (2002, November). Effectiveness of dialectical behavior therapy in a community mental health center. Paper presented at the annual meeting of the Association for Advancement of Behavior Therapy, Reno, NV.
20. Cone, J.D., & Hawkins, R.P. (1997). Behavioral assessment: New directions in clinical psychology. New York: Burner & Mazel.
21. Cook, E., & Turpin, G. (1997). Differentiating, orienting, startle, and defense responses: The role of affect and its implication for psychopathology. In P.J. Lang, R.F. Simons, & M.T. Balaban (Eds.), Attention and orientating: Sensory and motivational processes (pp. 137-164). Hillsdale, NJ: Erlbaum.
22. Craske, M.G., Barlow, D.H., & Meadows, E. (2000). Mastery of your anxiety and panic (MAP-3): Therapist guide for anxiety, panic, and agoraphobia (3rd ed.). San Antonio, TX: Graywind Publications/The Psychological Corporation.
23. Davidson, R., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S.F., et al. (2003). Alternations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.
24. Ditto, P., Scepansky, J., Munro, G., Apanovitch, A., & Lockhart, L. (1998). Motivated sensitivity to preference-inconsistent information. Journal of Personality and Social Psychology, 75, 53-69.
25. Foa, E.B., & Kozak, M.S. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.
26. Franklin, M.E., Abramowitz, J.S., Kozak, M.J., Levitt, J.T., & Foa, E.B. (2000). Effectiveness of exposure and ritual prevention for obsessive compulsive disorder: Randomized versus non-randomized samples. Journal of Consulting and Clinical Psychology, 68, 594-602.
27. Gellatly, I., & Meyer, J. (1992). The effects of goal difficulty on physiological arousal, cognition, and task performance. Journal of Applied Psychology, 77, 694-704.
28. Graham, F. (1979). Distinguishing among orienting, defense, and startle reflexes. In H.D. Kimmel, E.H. van Olst, & J.E. Orlebeke (Eds.), The orienting reflex in humans (pp. 137-167). Hillsdale, NJ: Erlbaum.
29. Gross, J.J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2, 271-299.
30. Hanh, T.N. (1976). Miracle of mindfulness. Boston: Beacon.
31. Hayes, S., Kohlenberg, B., & Melancon, S. (1989). Avoiding and altering rule-control as a strategy of clinical intervention. In S. Hayes (Ed.), Rule-governed behavior: Cognition, contingencies, and instructional control (pp. 359-385). New York: Plenum Press.
32. Hayes, S., Strosahl, K.D., & Wilson, K.G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.
33. Henggeler, S.W., Schoenwald, S.K., & Pickrel, S.G. (1995). Multisystemic therapy: Bridging the gap between university- and community-based treatment. Journal of Consulting and Clinical Psychology, 63, 709-717.
34. Hess, U., Kappas, A., McHugo, G.J., Lanzetta, J.T., et al. (1992). The facilitative effect of facial expression on the self-generation of emotion. International Journal of Psychophysiology, 12, 251-265.
35. Hixon, J., & Swann, W., Jr. (1993). When does introspection bear fruit? Self-reflection, self-insight, and interpersonal choices. Journal of Personality and Social Psychology, 64, 35-43.
36. Izard, C.E. (1971). The face of emotion. New York: Plenum Press.
37. Jones, B., Heard, H., Startup, M., Swales, M., Williams, J.M., & Jones, R.S. (1999). Autobiographical memory and dissociation in borderline personality disorder. Psychological Medicine, 29, 1397-1404.
38. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacourt.
39. Kaminstein, D.S. (1987). Toward a dialectical metatheory for psychotherapy. Journal of Contemporary Psychotherapy, 17, 87-101.
40. Kazdin, A.E., & Nock, M.K. (2003). Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44, 1116-1129.
41. Koenigsberg, H.W., Harvey, P.D., Mitropoulou, V., New, A.S., Goodman, M., Silverman, J., et al. (2001). Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affective instability and impulsivity? Journal of Personality Disorders, 15, 358-370.
42. Kohlenberg, J., & Tsai, M. (1991). Functional analytic psychotherapy: Creating intense and curative therapeutic relationships. New York: Plenum Press.
43. Koons, C., Chapman, A.L., Betts, B., O'Rourke, B., & Robins, C.J. (2006). Dialectical behavior therapy adapted for the vocational rehabilitation of significantly disabled mentally ill adults. Cognitive and Behavioral Practice, 13(2).
44. Koons, C., Robins, C.J., Tweed, J.L., Lynch, T.R., Gonzelez, A.M., Morse, J.Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371-390.
45. Kruedelbach, N., McCormick, R.A., Schulz, S.C., & Grueneich, R. (1993). Impulsivity, coping styles, and triggers for craving in substance abusers with borderline personality disorders. Journal of Personality Disorders, 7, 214-222.
46. Laird, J. (1974). Self-attribution of emotion: The effects of expressive behavior on the quality of emotional experience. Journal of Personality and Social Psychology, 29, 475-486.
47. Laird, J. (1984). The real role of facial response in the experience of emotion: A reply to Tourangeau and Ellsworth, and others. Journal of Personality and Social Psychology, 47, 909-917.
48. Lang, P.J., Levin, D.N., Miller, G.A., & Kozak, M.J. (1983). Fear behavior, fear imagery, and the psychophysiology of emotion: The problem of affective response integration. Journal of Abnormal Psychology, 92, 276-306.
49. Lazarus, R.S. (1991). Emotion and adaptation. New York: Oxford University Press.
50. LeDoux, J. (1996). The emotional brain. New York: Simon & Schuster.
51. LeDoux, J. (2002). Synaptic self. New York: Viking.
52. Lewis, M., Alessandri, S.M., & Sullivan, M.W. (1992). Differences in shame and pride as a function of children's gender and task difficulty. Child Development, 63, 630-638.
53. Linehan, M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
54. Linehan, M. (1993b). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
55. Linehan, M.M. (1999). Development, evaluation, and dissemination of effective psychosocial treatments: Levels of disorder, stages of care, and stages of treatment research. In M.G. Glantz & C.R. Hartel (Eds.), Drug abuse: Origins and interventions (pp. 367-394). Washington, DC: American Psychological Association.
56. Linehan, M.M., Armstrong, H.E., Suarez, A., Allmon, D., & Heard, H.L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060-1064.
57. Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L., et al. (2006). Suicidal and behavioral outcomes from a one year randomized trial and one year follow-up of Dialectical Behavior Therapy for borderline personality disorder. Manuscript submitted for publication.
58. Linehan, M., Dimeff, L., Reynolds, S., Comtois, K., Shaw-Welch, S., Heagerty, P., et al. (2002). Dialectical behavior therapy versus comprehensive validation plus 12 step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13-26.
59. Linehan, M., Schmidt, H., Dimeff, L., Craft, C., Kanter, J., & Comtois, K. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal of Addictions, 8, 279-292.
60. Lynch, T.R., Morse, J., Mendelson, T., & Robins, C. (2003). Dialectical behavior therapy for depressed older adults: A randomized pilot study. American Journal of Geriatric Psychiatry, 11, 33-45.
61. Lynch, T.R., Robins, C.J., Morse, J.Q., & Krause, E.D. (2001). A mediation model relating affect intensity, emotion inhibition, and psychological distress. Behavior Therapy, 32, 519-536.
62. Marlatt, G., & Gordon, J. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
63. Matsumoto, D. (1987). The role of facial response in the experience of emotion: More methodological problems and a meta-analysis. Journal of Personality & Social Psychology, 52, 769-774.
64. McCall, G., & Simmons, J. (1966). Identities and interactions: An examination of human associations in everyday life. New York: Free Press.
65. Otto, M.W., Smits, J.A.J., & Reese, H.E. (2004). Cognitive-behavioral treatment for anxiety disorders. Journal of Clinical Psychiatry, 65, 34-41.
66. Pavlov, I. (1927). Conditioned reflexes. London: Oxford University Press.
67. Philippot, P., Schaefer, A., & Herbette, G. (2003). Consequences of specific processing of emotional information: Impact of general versus specific autobiographical memory priming on emotion elicitation. Emotion, 3, 270-283.
68. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793-802.
69. Rathus, J.H., & Miller, A.L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life Threatening Behavior, 32, 146-157.
70. Rizvi, S., & Linehan, M.M. (in press). The treatment of maladaptive shame in borderline personality disorder: A pilot study of "opposite action." Cognitive and Behavioral Practice.
71. Robbins, S.J. (1990). Mechanisms underlying spontaneous recovery in autoshaping. Journal of Experimental Psychology: Animal Behavior Processes, 16, 235-249.
72. Robins, C.J., & Chapman, A.L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18, 73-79.
73. Rollnick, S., & Miller, W. (1995). What is motivational interviewing? Behavioural & Cognitive Psychotherapy, 23, 325-334.
74. Segal, Z., Williams, G., & Teasdale, J. (2002). Mindfulness based cognitive therapy. New York: Guilford Press.
75. Serna, L.A., Schumaker, J.B., Sherman, J.A., & Sheldon, J.B. (1991). In-home generalization of social interactions in families of adolescents with behavior problems. Journal of Applied Behavior Analysis, 24, 733-746.
76. Siddle, D., & Packer, J. (1987). Stimulus omission and dishabituation of the electrodermal orienting response: The allocation of processing resources. Psychophysiology, 24, 181-190.
77. Skodol, A., Gunderson, J., Pfohl, B., Widiger, T., Livesley, J., & Siever, L. (2002). The borderline diagnosis: 1. Psychopathology, comorbidity, and personality structure. Biological Psychiatry, 51, 936-950.
78. Sokolov, E. (1963). Perception and the conditioned reflex. Oxford: Pergamon.
79. Soussignan, R. (2002). Duchenne smile, emotional experience, and autonomic reactivity: A test of the facial feedback hypothesis. Emotion, 2, 52-74.
80. Stokes, T.F., & Baer, D.M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349-367.
81. Stokes, T.F., & Osnes, P.G. (1989). An operant pursuit of generalization. Behavior Therapy, 20, 337-355.
82. Strack, F., Martin, L., & Stepper, S. (1988). Inhibiting and facilitating conditions of the human smile: A nonobtrusive test of the facial feedback hypothesis. Journal of Personality & Social Psychology, 54, 768-777.
83. Swann, W., Jr. (1983). Self-verification: Bringing social reality into harmony with the self. In J. Suls & A. Greenwald (Eds.), Social psychological perspectives on the self (pp. 33-66). Hillsdale, NJ: Erlbaum.
84. Swann, W., Jr., Pelham, B., & Krull, D. (1989). Agreeable fancy or disagreeable truth? How people reconcile their self-enhancement and self-verification needs. Journal of Personality and Social Psychology, 57, 782-791.
85. Swann, W., Rentfrow, P., & Guinn, J. (2003). Self-verification: The search for coherence. Handbook of self and identity. New York: Guilford Press.
86. Swann, W., Jr., Stein-Seroussi, A., & Giesler, B. (1992). Why people self-verify. Journal of Personality and Social Psychology, 62, 392-401.
87. Tan, L., & Ward, G. (2000). A recency-based account of the primacy effect in free recall. Journal of Experimental Psychology: Learning, Memory, and Cognition, 26, 1589-1625.
88. Teasdale, J., Segal, Z., & Williams, J. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33, 25-39.
89. Telch, C.F., Agras, W.S., & Linehan, M.M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061-1065.
90. Tomkins, S.S. (1962). Affect, imagery, consciousness: Vol. 1. The positive effects. New York: Springer.
91. Tourangeau, R., & Ellsworth, P. (1979). The role of facial response in the experience of emotion. Journal of Personality & Social Psychology, 37, 1519-1531.
92. Tulving, E., Markowitsch, H., Kapur, S., Habib, R., & Houle, S. (1994). Novelty encoding networks in the human brain: Positron emission tomography data. NeuroReport, 5, 2525-2528.
93. Turner, R. (2000). Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7, 413-419.
94. Verheul, R., van den Bosch, L.M.C., Koeter, M.W.J., de Ridder, M.A.J., Stijnen, T., & van den Brink, W. (2003). Dialectical behavior therapy for women with borderline personality disorder. British Journal of Psychiatry, 182, 135-140.
95. Wachtel, P. (1977). Psychoanalysis and behavior therapy. New York: Basic Books.
96. Wagner, A., & Linehan, M. (1997). Biosocial perspective on the relationship of childhood sexual abuse, suicidal behavior, and borderline personality disorder. In M. Zanarini (Ed.), The role of sexual abuse in the etiology of borderline personality disorder (pp.203-223). Washington, DC: American Psychiatric Association.
97. Westen, D. (1991). Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline personality disorders. Clinical Psychology Review, 11, 211-230.
98. Whisman, M.A. (1993). Mediators and moderators of change in cognitive therapy of depression. Psychological Bulletin, 114, 248-265.
99. Whisman, M.A. (1999). The importance of the cognitive theory of change in cognitive therapy of depression. Clinical Psychology: Science & Practice, 6, 300-304.
100. Witkiewitz, K., & Marlatt, G.A. (2004). Relapse prevention for alcohol and drug problems: That was zen, this is tao. American Psychologist, 59, 224-235.
101. Wolpe, J. (1954). Reciprocal inhibition as the main basis of psychotherapeutic effects. Archives of Neurology & Psychiatry, 72, 205-226.