Distress Tolerance Treatment -- Aiding Substance Users
Oct 21, 2012
In my last post I briefly discussed the importance of Emotion Regulation training in the treatment of a number of disorders; among them, Complex Trauma, Borderline Personality Disorder, and in some cases at least, Posttraumatic Stress Disorder borne of childhood interpersonal trauma. I provided a link to a treatment manual for Emotion Regulation Group Therapy for those with Deliberate Self-Harm (DSH) and today I'd like to say a little more about Deliberate Self-Harm, Substance Use Disorder, and provide a link to a treatment manual for Distress Tolerance. Firstly, however, I'd like to make sure people are aware of the great variety and quality of resources available at the DBTSelfHelp website [LINK] Here's a link to the Distress Tolerance Treatment manual [LINK]
A little studied sign of psychological distress, Deliberate Self-Harm, in those victims of Intimate Partner Violence (IPV) has recently been studied by Jill Messing, Professor of Social Work at Arizona State University [LINK] Not surprisingly, one of the forms of trrauma, victims of Complex Trauma may experience is witnessing their caregiver (in my case, my mother) being subject to such violence, and experiencing the effects of such violence on their caregiver (this can include, but not necessarily) their caregiver's experience of Posttraumatic Stress Disorder, Depression, Anxiety Disorder(s), or Substance Use Disorder. Naturally, the attachment relationship is put under a great deal of stress, often over a long time, with consequent negative impact on children's capacity to develop satisfactory self-image, self-regulation, and relationships in adult life.
Messing's study was of clients in residential substance use treatment and who were assessed as having low tolerance for psychological distress on laboratory distress tolerance measures were randomized into three conditions: Treatment-As-Usual (TAU), six sessions of Supportive Counseling (SC), or six sessions of the novel distress tolerance treatment, Skills for Improving Distress Intolerance (SIDI). Patients were assessed at baseline for DSM-IV psychiatric diagnoses, DSM-IV substance use disorders, distress tolerance, and depressive symptoms. Patients were again assessed at posttreatment. Therapeutic alliance and treatment expectancies and credibility were also assessed at posttreatment. :Patients who received SIDI (n=28) evidenced significantly greater improvements than SC (n=24) and TAU participants (n=24) on the distress tolerance laboratory measures, even when controlling for changes in negative affect (in the form of depression). This is noteworthy, given the results of a study by Iverson et al [LINK] who failed to find any effect for emotion regulation and distress tolerance when controlling for depression -- to be reviewed in a future post. Additionally, a higher percentage of patients in SIDI reached clinically significant improvement compared to patients in SC and TAU. This study supports the efficacy of SIDI in improving distress tolerance levels among individuals with substance use disorders currently receiving residential substance use treatment. SIDI appears to be a brief and feasible intervention for use within inpatient substance use facilities. This is an important result but whether it will translate into better longterm substance use outcomes, and other "functional outcomes" remains to be demonstrated. Such other "functional outomes" include persistence in "goal directed activity" -- performance of interpersonal, social and vocational outcomes, say. "Distress Tolerance" is, after all, the ability to persist in goal directed activity when experiencing psychological distress.
Messing's study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between child-hood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the rela-tionship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Messing et al argue that screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization. Perhaps, Distress Tolerance is also one of the types of treatment of potential value to victims of intimate partner violence.
October 23, 2012 -- [LINK] Kate Iverson's paper just received -- will be reviewed in a future post