Dialectical Behavior Therapy for veterans with cognitive and psychiatric impairments: A pilot program

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The intent of this pilot study was to assess the efficacy of a modified version of Marsha Linehan's (1993) Dialectical Behavior Therapy (DBT) Skills Training modules for use with a military veteran population. The therapy intervention targeted the shared symptomatology resulting from diverse diagnoses within psychiatric, neurocognitive, and behavioral domains, regardless of etiology, with the goals of improving veteran's infra- and inter-personal experience. Pre- and post-treatment measures were administered to identify changes in attention, mindfulness, verbal learning/memory, and mood. Because mindfulness specifically remediates attention processes and emotion regulation, improvement in these domains were expected. Statistical analyses compared pre- and post-assessments using dependant paired two sample, 2-tailed t-tests, with alpha = .05. 16 veterans (15 males, 1 female), ranging in age from 26-64, completed the protocol and both pre- and post-treatment measures. Anxiety showed no significant decrease as measured by Beck Anxiety Inventory (t .16). A significant decrease was shown in depression (t .00) as measured by Beck Depression Inventory. Attention and verbal learning showed no significant improvement as measured by Digit Symbol Coding (t .51), Digit Span Forward (t .11), and Digit Span Backward (t 1.00); however there was a possible trend toward improvement when measure by Trail Making Test A (t .07) and Trail Making Test B (t .06). Mindfulness Awareness significantly increased (t .04) as measured by the Mindfulness Attention Awareness Scale. Improved coping response to stressfid events was shown with a decrease in cognitive avoidance (t .02) as measured by the Coping Response Inventory-Cognitive Avoidance, and a possible trend toward increased seeking guidance and support in response to stressful events was shown (t .09) as measured by the Coping Response Inventory-Seeking Guidance and Support. The results of this study show that modified DBT was effective in a veteran population with persistent cognitive and psychiatric impairments, and represents an efficacious and potentially cost-effective treatment approach in group therapy format that integrates cognitive and psychiatric interventions in a relatively brief model (12 sessions), as contrasted to segregated mental health and/or cognitive rehabilitation therapies, or longer-term individual therapies.

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  • Patricia Spiva

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