The effectiveness of dialectical behavioral therapy on self-harmful and distress tolerance in adolescents with a history of self-harmful behaviors

Azizi, Majid; Zarei, Iqbal

doi:10.22055/psy.2022.38177.2726

Document Type : Research Article

Authors

Majid Azizi ¹
Iqbal Zarei ²

¹ department psychology, azad university of bandar abbas

² Associate Professor, Department of Psychology and Counseling, Humanities, Hormozgan, Bandar Abbas, Iran

https://doi.org/10.22055/psy.2022.38177.2726

Abstract

Introduction
Suicidal behaviors and self-harmful are one of the phenomena that has created a major challenge for mental health. Self-assessment in adolescents usually expresses high psychological distress. The prevalence of this problem indicates adolescents’ discontent, that has lots of effects on the other family members and friends. Self-assessment without suicide intention is actually self-employed or any kind of action that harms a person, but in this person, there is no intention to die, and ultimately, suicide behavior is without the intention of suicide, which causes suicide without having a person to finish his life. Therefore, the present study aimed to investigate the effectiveness of dialectical behavioral therapy on self-harmful behaviors and distress tolerance in adolescents to answer the questions of if the dialectical treatment affects the beatings and tolerance of distress.
Method
The present study was a quasi-experiment with pretest post-test with control group and one-month follow-up period. The statistical population of this study was all adolescents referring to Bandar Abbas counseling clinics with a history of self-harmful behaviors. In this study, 30 patients were selected by voluntary and targeted non-targeted sampling and randomly assigned to the experimental and control groups (15 in the experimental group and 15 in the control group) experimental group of dialectics treatment in 12 sessions of 2 hours received. The questionnaires used in this study included self-harmful behaviors questionnaire (Klonsky & Glenn, 2009) and distress tolerance questionnaire (Simmons and Gahr, 2005). Data from the research was analyzed by repeated measure ANOVA.
Results
The results showed that Dialectical behavior therapy based on Dimeff and Linehan (2008) therapy package on the experimental group has been effective in beating and tolerating distress in adolescents, since this treatment has been successful in improving self-harmful behaviors and tolerance of distress. Also, the results showed that dialectical behavioral therapy remained fixed on self-harmful behaviors and distress tolerance in adolescents in follow-up stage
Discussion
According to the findings of this study, it can be concluded that dialectical behavioral therapy can be used as an effective therapeutic treatment for improving the behavior of self-esteem and tolerance in adolescents with a history of self-regulation by educating the skills of excitement, tolerance of distress, conscious mind are being used. Dialectical behavior training can be effective in reducing self-control behaviors. The results of this study with the findings of Chesli et al (2020), Abooutorabi Kashani et al (2020), Saffarinia et al (2015), zamani (2014), ghorbani (2018), Tabatabayi (2021), alavi (2012), Peymannia et al (2019) is a coherent research. Explaining the findings, it can be said that dialectical behavior therapy emphasizes learning resilience against pain in a skillful way, and it can be concluded that disturbed behaviors that are targeted in teaching dialectical behavior therapy skills to endure and survive in crises. And accepting life as it is in the present moment, and these strategies in the form of turning attention (when engaging in self-harming behavior), calming down (in time of distress), improving the moment, and thinking about the benefits and harms of self-injurious behavior.

Keywords

References

Abedi, A. (2011). Challenges and strategies for effective evaluation of social programs. Journal of Research, 3(2), 139-155. [Persian]

Abootorabi Kashani, P., Naderi, F., Safar zadeh, S., Hafezi, F., & Eftekhar Saadi, Z. (2020). Comparison of the effect of dialectical behavior therapy and emotion regulation on distress tolerance and suicide ideation in symptoms of attention deficit/hyperactivity disorder in adolescents. Journal of Psychological Achievements, 27(2), 69-88. [Persian]

Anestis, J. C., Charles, N. E., Lee-Rowland, L. M., Barry, C. T., & Gratz, K. L. (2020). Implementing dialectical behavior therapy skills training with at risk male youth in a military-style residential program. Cognitive and Behavioral Practice, 27(2), 169-183.

Angelotta, C. (2015). Defining and refining self-harm: A historical perspective on nonsuicidal self-injury. The Journal of Nervous and Mental Disease, 203(2), 75-80.

Azizi, A. R., Mirzai, A., & Shams, J. (2010). The relationship between distress tolerances, emotion regulation of student's dependence on cigarettes. Hakim Research Journal, 13(1), 11-18. [Persian]

Bagean Koulemarz, M., Karami, J., Momeni, K. & Elahi, A. (2019). The effect of integration of dialectical behavior therapy based on compassionate mind on reduction of cognitive reactivity and motivation for suicide attempts in attempted suicide. Journal of Psychological Achievements, 26(2), 1-26. [Persian]

Barnard-Brak, L., Roberts, B. & Valenzuela, E. (2020). Examining breaks and resistance in medication adherence among adolescents with ADHD as associated with school outcomes. Journal of Attention Disorders, 24(8), 1148-1155.

Bjureberg, J., Ohlis, A., Ljótsson, B., D'Onofrio, B.M., Hedman-Lagerlöf, E., Jokinen, J., Sahlin, H., Lichtenstein, P., Cederlöf, M., & Hellner, C. (2019). Adolescent self-harm with and without suicidality: Cross-sectional and longitudinal analyses of a Swedish regional register. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60(3), 295-304.

Lindgren, B. M., Wikander, T., Neyra Marklund, I., & Molin, J. (2022). A necessary pain: A literature review of young people's experiences of self-harm. Issues in Mental Health Nursing, 43(2), 154-163.

Dawkins, J. C., Hasking, P. A., Boyes, M. E., Greene, D., & Passchier, C. (2019). Applying a cognitive‐emotional model to nonsuicidal self‐injury. Stress and Health, 35(1), 39-48.

Dewhirst, C. (2019). Evaluation of learning and teaching. Queens University Belfast: Northern Ireland.

Ellis, A. J., Salgari, G., Miklowitz, D. & Loo, S. K. (2018). Is distress tolerance an approach behavior? An examination of frontal alpha asymmetry and distress tolerance in adolescents. Psychiatry Research, 267, 210-214.

Hicks, K. M., & Hinck, S. M. (2008). Concept analysis of self-mutilation. Journal of Advanced Nursing, 64(4), 408-413.

International Society for the Study of Self-Injury (ISS). (2018, May). What is self-injury? https://itriples.org/about-self-injury/what-is-self-injury.

Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 11(2), 129-147.

Kim, S., Kim, Y., & Hur, J. W. (2019). Nonsuicidal self-injury among Korean young adults: a validation of the Korean version of the inventory of statements about self-injury. Psychiatry Investigation, 16(4), 270-285.

Kleiman, E. M., Ammerman, B., Look, A. E., Berman, M. E., & McCloskey, M. S. (2014). The role of emotion reactivity and gender in the relationship between psychopathology and self-injurious behavior. Personality and Individual Differences, 69, 150-155.

Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: Prevalence, sociodemographics, topography and functions. Psychological Medicine, 41(9), 1981-1986.

Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the Inventory of Statements About Self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215-219.

Landstedt, E., & Gillander, G. (2011). Deliberate self-harm and associated factors in 17-year-old Swedish students. Scandinavian Journal of Public Health, 39(1), 17-25.

Lee W. K. (2016). Psychological characteristics of self-harming behavior in Korean adolescents. Asian Journal of Psychiatry, 23, 119-124.

Long, M., Manktelow, R., & Tracey, A. (2013). We are all in this together: Working towards a holistic understanding of self-harm. Journal of Psychiatric and Mental Health Nursing, 20(2), 105-113.

Mehlum, L., Ramleth, R. K., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., & Grøholt, B. (2019). Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior. Journal of Child Psychology and Psychiatry, 60(10), 1112-1122.

Miller, A. L., Muehlenkamp, J. J., & Jacobson, C. M. (2008). Fact or fiction: diagnosing borderline personality disorder in adolescents. Clinical Psychology Review, 28(6), 969-981.

Mitchell, R., Roberts, R., Bartsch, D. & Sullivan, T. (2019). Changes in mindfulness facets in a dialectical behavior therapy skills training group program for borderline personality disorder. Journal of Clinical Psychology, 75(6), 958-969.

Møhl, B., & Skandsen, A. (2012). The prevalence and distribution of self-harm among Danish high school students. Personality and Mental Health, 6(2), 147-155.

Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6, 1-9.

Nada-Raja, S., Skegg, K., Langley, J., Morrison, D., & Sowerby, P. (2004). Self-harmful behaviors in a population-based sample of young adults. Suicide & Life-Threatening Behavior, 34(2), 177-186.

Nadimi, M. (2016). Effectiveness of dialectical behavior therapy (based on skills training) on reduce impulsivity and increase emotional regulation in women dependent on Methamphetamine. Rooyesh-e-Ravanshenasi Journal, 5(1), 47-74. [Persian]

Navarro-Haro, M. V., Modrego-Alarcón, M., Hoffman, H. G., López-Montoyo, A., Navarro-Gil, M., Montero-Marin, J. & Garcia-Campayo, J. (2019). Evaluation of a mindfulness-based intervention with and without virtual reality dialectical behavior therapy mindfulness skills training for the treatment of generalized anxiety disorder in primary care: A pilot study. Frontiers in Psychology, 10(55), 85-97.

Owen, s. D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. Systematic review. The British Journal of Psychiatry: The Journal of Mental Science, 181, 193-199.

Peymannia, B., Hamid, N., & Mhmudalilu, M. (2018). The Effectiveness of ACT Matrix with compassion on self-injury behaviors and quality of life of Students with symptoms of Borderline Personality Disorders. Journal of Psychological Achievements, 25(1), 23-44. [Persian]

Porter, M., Gracia, R., Oliva, J. C., Pàmias, M., Garcia-Parés, G., & Cobo, J. (2016). Mental health emergencies in paediatric services: Characteristics, diagnostic stability and gender differences. Actas Espanolas de Psiquiatria, 44(6), 203-211.

Rezaei, Z., Vahed, N., Rasuli-Azad, M., Mousavi, G. A., & Ghaderi, A. (2019). Effect of dialectical behavior therapy on emotion regulation and distress tolerance in people under methadone therapy. KAUMS Journal (FEYZ), 23(1), 52-60. [Persian]

Schmitgen, M. M., Niedtfeld, I., Schmitt, R., Mancke, F., Winter, D., Schmahl, C., & Herpertz, S. C. (2019). Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging. Brain and Behavior, 1(2), 1-12

Shooshtari, M. H., & Khanipour, H. (2014). Comparison of self-harm and suicide attempt in adolescents: a systematic review. Iranian Journal of Psychiatry & Clinical Psychology, 20(1), 3-13. [Persian]

Soloff, P. H., Lynch, K. G., Kelly, T. M., Malone, K. M., & Mann, J. J. (2000). Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. The American Journal of Psychiatry, 157(4), 601-608.

Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83-102. http://dx.doi.org/10.1007/s11031 -005-7955-3

Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021). Interventions for self-harm in children and adolescents. The Cochrane Database of Systematic Reviews, 3(3), CD013667.

World Health Organization (2021). Adolescent Mental Health. Available online. https://www.who.int/news-room/fact-sheets/detail/adolescent-mentalhealth.

Ystgaard, M., Arensman, E., Hawton, K., et al. (2008). Deliberate self-harm in adolescents: Comparison between those who receive help following self-harm and those who do not. Journal of Adolescence, 32(4), 875-891.

Zamani, N., Noohi, S., Teimouri, N. N. & Jahangir, A. H. (2016). Effectiveness of dialectical behavior therapy for reducing suicidal thoughts (suicidal ideations) in suicide attempters with a history of previous suicide. Health Research, 1(3), 159-166. [Persian]

The effectiveness of dialectical behavioral therapy on self-harmful and distress tolerance in adolescents with a history of self-harmful behaviors

References

References

Volume 30, Issue 1 - Serial Number 29January 2023Pages 145-162

Volume 30, Issue 1 - Serial Number 29
January 2023
Pages 145-162