Abstracts
Résumé
Les personnes souffrant d’un trouble de la personnalité borderline (TPL) représentent une proportion importante de la clientèle hospitalisée en psychiatrie et de la clientèle ambulatoire. Elles consomment jusqu’à 40 % des ressources en santé mentale. La thérapie comportementale dialectique (TCD) est l’une des thérapies les mieux validées dans les écrits scientifiques pour traiter cette clientèle. Malheureusement, son déploiement au Québec demeure assez limité, entre autres à cause d’un manque de ressources pour offrir la thérapie individuelle et les appels téléphoniques d’urgence. Même si l’approche globale, telle que préconisée initialement, est peu accessible, plusieurs départements de psychiatrie proposent des groupes d’entraînement aux compétences aux personnes souffrant de TPL. Cet article vise à dresser un bref portrait de ce qu’est la TCD, de rendre compte des études sur les groupes TCD et de quelques adaptations existantes. L’auteure présentera le modèle appliqué dans deux milieux psychiatriques québécois, le Centre de santé et de services sociaux du Sud de Lanaudière et le pavillon Albert-Prévost, ainsi que les adaptations prévues dans le cadre du plan d’action en santé mentale.
Mots-clés :
- groupe d’entraînement aux compétences,
- thérapie comportementale dialectique,
- personnalité borderline,
- adaptations
Abstract
Patients suffering from borderline personality disorder (BPD) represent a substantial proportion of hospitalized and outpatient patients in psychiatry. They use up to 40% of mental health resources. Dialectical behavioral therapy (DBT) is one of the best studied treatment for this population. Unfortunately, its deployment in Quebec remains quite limited partly because resources are lacking to provide individual therapy and a response to emergency calls. Although the complete package, as originally studied, is not widely available, several psychiatric departments offer skills training groups for patients with BPD. This article aims to provide a brief overview of the DBT model, review studies on DBT groups and some existing adaptations to the original model. The author will also present the model used in two psychiatric settings, the Centre de Santé et Services Sociaux du Sud de Lanaudière and Pavilion Albert-Prévost, as well as the adaptations in the context of transfers to community health settings.
Keywords:
- dialectical behavior therapy,
- skills training,
- borderline personality disorder,
- adaptations
Appendices
Bibliographie
- Åkerlund, R. (2012). An Empirical Evaluation of Dialectical Behavior Therapy Skills Training for Residential Treatment Center Staff.
- Bégin, C. et Lefebvre, D. (1997). La psychothérapie dialectique comportementale des personnalités limites. Santé mentale au Québec, 22(1), 43-68.
- Black, D. W., Blum, N., Eichinger, L., McCormick, B., Allen, J. et al. (2008). STEPPS : systems training for emotional predictability and problem solving in women offenders with borderline personality disorder in prison-a pilot study. CNS Spectr., 13(10), 881-886.
- Black, D. W., Blum, N., Pfohl, B. et Hale, N. (2004). Suicidal behavior in borderline personality disorder : prevalence, risk factors, prediction, and prevention. Journal of Personality Disorders, 18(3 : Special issue), 226-239.
- Blackford, J. U. et Love, R. (2011). Dialectical behavior therapy group skills training in a community mental health setting : a pilot study. International Journal of Group Psychotherapy, 61(4), 645.
- Blum, N., John, D. S., Pfohl, B., Stuart, S., McCormick, B. et al. (2008). Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder : a randomized controlled trial and 1-year follow-up. The American Journal of Psychiatry, 165(4), 468.
- Blum, N., Pfohl, B., John, D. S., Monahan, P. et Black, D. W. (2002). STEPPS : a cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder – a preliminary report. Comprehensive Psychiatry, 43(4), 301-310.
- Booth, R., Keogh, K., Doyle, J. et Owens, T. (2012). Living through distress : a skills training group for reducing deliberate self-harm. Behavioural and Cognitive Psychotherapy, 1(1), 1-10.
- Bos, E. H., van Wel, E. B., Appelo, M. T. et Verbraak, M. J. (2010). A randomized controlled trial of a Dutch version of systems training for emotional predictability and problem solving for borderline personality disorder. The Journal of Nervous and Mental Disease, 198(4), 299-304.
- Bos, E. H., Wel, B. V., Appelo, M. T. et Verbraak, M. J. P. M. (2012). Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Borderline Personality Problems in a « Real-World » Sample : Moderation by Diagnosis or Severity ?
- Brazier, J. E., Tumur, I., Holmes, M., Ferriter, M., Parry, G., Dent-Brown, K. et al. (2006). Psychological therapies including dialectical behaviour therapy for borderline personality disorder : a systematic review and preliminary economic evaluation.
- Christensen, D. R., Dowling, N. A., Jackson, A. C., Brown, M., Russo, J. et al. (2013). A Proof of Concept for Using Brief Dialectical Behavior Therapy as a Treatment for Problem Gambling. Behaviour Change, 30(02), 117-137.
- Clarkin, J. F., Levy, K. N., Lenzenweger, M. F. et Kernberg, O. F. (2004). The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder : rationale, methods, and patient characteristics. Journal of Personality Disorders, 18(1), 52-72.
- Dimeff, L. A. et Koerner, K. E. (2007). Dialectical behavior therapy in clinical practice : Applications across disorders and settings. New York : Guilford Press.
- Drossel, C., Fisher, J. E. et Mercer, V. (2011). A DBT skills training group for family caregivers of persons with dementia. Behavior Therapy, 42(1), 109-119.
- Feliu-Soler, A., Pascual, J. C., Borràs, X., Portella, M. J., Martín-Blanco, A. et al. (2013). Effects of Dialectical Behaviour Therapy-Mindfulness Training on Emotional Reactivity in Borderline Personality Disorder : Preliminary Results. Clinical psychology & psychotherapy.
- Freije, H., Dietz, B. et Appelo, M. (2002). Behandeling van de borderline persoonlijkheidsstoornis met de VERS : de vaardigheidstraining emotionele regulatiestoornis. Dth, 22(4), 160-166.
- Fruzzetti, A. E. et Levensky, E. R. (2000). Dialectical behavior therapy for domestic violence : Rationale and procedures. Cognitive and Behavioral Practice, 7(4), 435-447.
- Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T.D. et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder : results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 69(4), 533.
- Gratz, K. L. et Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy, 37, 25-35.
- Gratz, K. L., Tull, M. T. et Levy, R. (2013). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychological Medicine, 1-14.
- Harley, R. M., Baity, M. R., Blais, M. A. et Jacobo, M. C. (2007). Use of dialectical behavior therapy skills training for borderline personality disorder in a naturalistic setting. Psychotherapy Research, 17(3), 351-358.
- Harley, R., Sprich, S., Safren, S., Jacobo, M. et Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of Nervous and Mental Disease, 196(2), 136-143.
- Hesslinger, B., van Elst, L. T., Nyberg, E., Dykierek, P., Richter, H., Berner, M. et Ebert, D. (2002). Psychotherapy of attention deficit hyperactivity disorder in adults. European Archives of Psychiatry and Clinical Neuroscience, 252(4), 177-184.
- Hoffman, P. D., Fruzzetti, A. E., Buteau, E., Neiditch, E. R., Penney, D. et al. (2005). Family connections : a program for relatives of persons with borderline personality disorder. Family Process, 44(2), 217-225.
- Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., Johnson, A., … et Nordström, A. L. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group : Results from a randomized controlled trial. Behaviour Research and Therapy, 49(3), 175-185.
- Keuthen, N. J., Rothbaum, B. O., Falkenstein, M. J., Meunier, S., Timpano, K. R., Jenike, M. A. et al. (2011), DBT-enhanced habit reversal treatment for trichotillomania : 3-and 6-month follow-up results. Depress. Anxiety, 28 : 310-313.
- Kroll, J., Sines, L., Martin, K., Lari, S., Pyle, R. et al. (1981). Borderline personality disorder : Construct validity of the concept. Archives of General Psychiatry, 38(9), 1021.
- Lindenboim, N., Comtois, K. A. K. et Linehan, M. M. (2007). Skills practice in dialectical behavior therapy for suicidal women meeting criteria for borderline personality disorder. Cognitive and Behavioral Practice, 14(2), 147-156.
- Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J. et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757.
- Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder, New York, NY Guiford Press.
- Linehan, M. M. et Korslund, K. E. (2013, octobre). Interpersonal Effectiveness. Communication présentée à la formation sur l’Enseignement des compétences, troisième formation, organisée par l’Institut Philippe-Pinel de Montréal, Montréal, Canada.
- Linehan, M. M., Rizvi, S. L., Welch, S. S. et Page, B. (2000). Psychiatric aspects of suicidal behaviour : personality disorders. The International Handbook of Suicide and Attempted Suicide, 147-178.
- Lynch, T. R., Cheavens, J. S., Cukrowicz, K. C., Thorp, S. R., Bronner, L. et al. (2007). Treatment of older adults with co-morbid personality disorder and depression : a dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22(2), 131-143.
- Lynch, T. R., Morse, J. Q., Mendelson, T. et Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults : A randomized pilot study. The American Journal of Geriatric Psychiatry, 11(1), 33-45.
- McMain, S. (2013). The Dialectical behavior therapy model. Récupéré le 27 octobre 2013 du site : http://ihmri.uow.edu.au/content/groups/public/@web/@ihmri/documents/doc/uow155502.pdf
- McMain, S. F., Guimond, T., Streiner, D. L., Cardish, R. J. et Links, P. S. (2012). Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder : clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry, 169(6), 650-661.
- McMain, S., Links, P., Gnam, W., Guimond, T., Cardish, R. et al. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1365-1374.
- Modestin, J., Abrecht, I., Tschaggelar, W. et Hoffman, H. (1997). Diagnosing Borderline : A contribution to the question of its conceptual validity. Archives Psychiatrica Nervenkra, 233, 359-370.
- National Collaborating Centre for Mental Health. (2009). Borderline Personality Disorder : The NICE GUIDELINE on Treatment and Management. National Clinical Practice Guideline 78. Leicester and London : The British Psychological Society and the Royal College of Psychiatrists.
- National Health and Medical Research Council. Clinical Practice Guideline for the Management of Borderline Personality Disorder. Melbourne : National Health and Medical Research Council ; 2012.
- Neacsiu, A. D., Rizvi, S. L. et Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832-839.
- Nelson-Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B. et al. (2006). A modified DBT skills training program for oppositional defiant adolescents : Promising preliminary findings. Behaviour Research and Therapy, 44(12), 1811-1820.
- Pasieczny, N. et Connor, J. (2011). The effectiveness of dialectical behaviour therapy in routine public mental health settings : An Australian controlled trial. Behaviour Research and Therapy, 49(1), 4-10.
- Perepletchikova, F., Axelrod, S. R., Kaufman, J., Rounsaville, B. J., Douglas-Palumberi, H. et al. (2011). Adapting Dialectical Behaviour Therapy for Children : Towards a New Research Agenda for Paediatric Suicidal and Non-Suicidal Self-Injurious Behaviours. Child and Adolescent Mental Health, 16(2), 116-121.
- Philipsen, A., Graf, E., Jans, T., Matthies, S., Borel, P. … et Berger, M. (17 oct. 2013). A randomized controlled multicenter trial on the multimodal treatment of adult attention-deficit hyperactivity disorder : enrollment and characteristics of the study sample. Atten Defic Hyperact Disord. [Epub ahead of print] PMID : 24132867.
- Philipsen, A., Graf, E., van Elst, L. T., Jans, T., Warnke, A., Hesslinger, B., … et Berger, M. (2010). Evaluation of the efficacy and effectiveness of a structured disorder tailored psychotherapy in ADHD in adults : study protocol of a randomized controlled multicentre trial. ADHD Attention Deficit and Hyperactivity Disorders, 2(4), 203-212.
- Philipsen, A., Richter, H., Peters, J., Alm, B., Sobanski, E., Colla, M., … et Hesslinger, B. (2007). Structured group psychotherapy in adults with attention deficit hyperactivity disorder : results of an open multicentre study. The Journal of Nervous and Mental Disease, 195(12), 1013-1019.
- Rajalin, M., Wickholm-Pethrus, L., Hursti, T. et Jokinen, J. (2009). Dialectical behavior therapy-based skills training for family members of suicide attempters. Archives of Suicide Research, 13(3), 257-263.
- Ritschel, L. A., Cheavens, J. S. et Nelson, J. (2012). Dialectical Behavior Therapy in an Intensive Outpatient Program With a Mixed-Diagnostic Sample. Journal of Clinical Psychology, 68(3), 221-235.
- Rizvi, S. L., Steffel, L. M. et Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology : Research and Practice, 44(2), 73.
- Safer, D. L. et Joyce, E. E. (2011). Does rapid response to two group psychotherapies for binge eating disorder predict abstinence ? Behaviour Research and Therapy, 49(5), 339-345.
- Safer, D. L., Telch, C. F. et Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632-634.
- Safer, D. L., Robinson, A. H. et Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder : comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy, 41(1), 106-120.
- Sakdalan, J. A., Shaw, J. et Collier, V. (2010). Staying in the here-and-now : A pilot study on the use of dialectical behaviour therapy group skills training for forensic clients with intellectual disability. Journal of Intellectual Disability Research, 54(6), 568-572.
- Sakdalan, J. A. et Collier, V. (2012). Piloting an Evidence-Based Group Treatment Program for High Risk Sex Offenders with Disability in the New Zealand Setting.
- Sambrook, S., Abba, N. et Chadwick, P. (2007). Evaluation of DBT emotional coping skills groups for people with parasuicidal behaviours. Behavioural and Cognitive Psychotherapy, 35(02), 241-244.
- Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J. et al. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder : a 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47(5), 353-358.
- Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J. et al. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150-157.
- Stepp, S. D., Epler, A. J., Jahng, S. et Trull, T. J. (2008). The effect of dialectical behavior therapy skills use on borderline personality disorder features. Journal of Personality Disorders, 22(6), 549-563.
- Stoffers, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N. et Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev, 8.
- Swartz, M., Blazer, D., George, L. et Winfield, I. (1990). Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 4(3), 257-272.
- Van Dijk, S., Jeffrey, J. et Katz, M. R. (2012). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders.
- Widiger, T. A. et Frances, A. J. (1989). Epidemiology, diagnosis, and comorbidity of borderline personality disorder. Review of Psychiatry, 8, 8-24.
- Widiger, T. A. et Weissman, M. M. (1991). Epidemiology of borderline personality disorder. Hospital and Community Psychiatry, 42(10), 1015.
- Yen, S., Johnson, J., Costello, E. et Simpson, E. B. (2009). A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder : predictors of outcome from a 3-month follow-up study. Journal of Psychiatric Practice, 15(3), 173.
- Zanarini, M. (2013). Borderline Personality Disorder : long-term course and treatment. Congrès de l’AMPQ.
- Zanarini, M. C. et Frankenburg, F. R. (2008). A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. Journal of Personality Disorders, 22(3), 284-290.
- Zanarini, M., Frankenburg, F., Reich, D., Silk, K., Hudson, J. et al. (2007). The subsyndromal phenomenology of borderline personality disorder : a 10-year follow-up study. American Journal of Psychiatry, 164(6), 929-935.
- Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., … et Smalley, S. L. (2008). Mindfulness meditation training in adults and adolescents with ADHD a feasibility study. Journal of Attention Disorders, 11(6), 737-746.