Preliminary Effectiveness of a Dialectical Behavior Therapy Skills-Infused College Course in the Context of the COVID-19 Pandemic

Authors: Carla Chugani, PhD¹, Robert W.S. Coulter, PhD, MPH², Barbara Fuhrman, PhD¹, and Elizabeth Miller, MD, PhD¹

Affiliation(s):¹University of Pittsburgh School of Medicine,²University of Pittsburgh School of Public Health

Abstract:

Background:  With one third of first year college students screening positive for a mental health disorder globally, collegiate mental health is an area of serious public health concern.  The need for mental health services often outpaces the availability of both on-campus and local resources, putting college campus providers in a difficult bind.  A relatively new trend among undergraduate programs is the provision of “happiness classes.” These courses are often grounded in evidence-based fields, such as positive psychology, and are tremendously popular among students.  However, a dearth of research exists to demonstrate whether such courses are associated with meaningful improvements in mental health.  Given the prevalence of mental disorders among undergraduate students, we sought to explore the acceptability, feasibility, and preliminary effectiveness of a course titled, “Wellness and Resilience for College and Beyond.” The wellness course was developed to include skills from dialectical behavior therapy, acceptance and commitment therapy, and positive psychology.  During the first semester of the study, the COVID-19 pandemic began.  Increased psychological problems such as anxiety, depression, and post-traumatic stress disorder are common during and following outbreaks of disease and disasters.  As such, we expanded our original research questions to investigate the difference in mental health outcomes among students who did or did not receive the wellness course during the COVID-19 pandemic.

Method:  Five college campuses in Western Pennsylvania and West Virginia were recruited to participate.  Course instructors participated in a 3-day training event delivered by the original course developer (Dr. James Mazza).  As the primary study outcomes are course acceptability, appropriateness, and feasibility, we did not randomized students to conditions; a sample of students receiving “university as usual” were recruited from each site to serve as a comparison group. During the Spring 2020 semester, a total of 10 course instructors and 172 college students (n=53 intervention, n=119 control) participated.  Assessments measuring primary outcomes (acceptability, appropriateness, and feasibility) as well as secondary outcomes (e.g., coping skills use, emotion dysregulation, past 30-day suicide ideation and risk) are conducted via electronic survey at baseline, end of semester, and 3-month follow-up.  Items related to COVID-19 including (but not limited to) whether students had tested positive for COVID-19 or had a loved one who had tested positive, if students had a health condition that would increase their risk for serious illness associated with COVID-19, and how concerned students were about access to food, housing, health, and isolation were added to end of semester and 3-month follow-up surveys.

Results:  Data collection for the Spring 2020 semester is ongoing.  This talk will present preliminary findings from the Spring 2020 cohort (n=172) for which data were collected prior to (January 2020), during (April 2020), and after (July 2020) the COVID-19 pandemic.

Suicidal Behaviors in BPD and Low-Risk Mothers: Is Motherhood Protective?

Authors: Christina Gamache Martin, PhD and Maureen Zalewski, PhD

Affiliation(s): University of Oregon

Abstract:

This lighting round presentation will contain a total of three slides to: 1) summarize the research to date on suicide risk for mothers, 2) illustrate results from our pilot study, and 3) discuss the role of parenthood as a protective factor in suicide risk assessments.

The risk for death by suicide has increased dramatically for middle-aged women, with a corresponding dearth of research and prevention efforts aimed at this demographic. Motherhood, a core characteristic of this demographic is commonly considered a protective factor for suicide. For women with borderline personality disorder (BPD), who typically have comorbid mental health problems and a prior history of suicidal behaviors, motherhood may not be a blanket protective factor. The current pilot study sought to examine the prevalence rates of suicidal behaviors in mothers with children aged 3-4 years old, with elevated BPD symptoms and mothers with no history of mental health problems since the conception of their child. We examined the prevalence of and differences in suicidal behaviors, including ideation, in a sample of 69 mothers (n = 37 BPD; n = 32 low-risk). Mothers reported on suicidal behaviors during a clinical interview, as part of a larger study. Rates of maternal suicide behaviors for the current sample were as follows—lifetime-52%, since conception-14%, past year-22%, current-9%, and future likelihood-22%. Significant group differences were found for lifetime suicidal behaviors and for the future likelihood of suicidal behaviors, where BPD mothers were significantly more likely to endorse suicidal behaviors in comparison to the low-risk mothers (Table 1). In contrast, BPD mothers were not more likely to endorse suicidal behaviors during periods of motherhood. These pilot data fit the lightning round well because they are succinct and lend to a thoughtful discussion examining the role of motherhood in suicide risk assessment.

Effectively Applying DBT in a Partial Hospital Program

Authors: John Lothes, Ed.D.^{1, 2}, Kirk Mochrie, Ph.D.³, Eric Guendner, M.A.^{1, 2}, and Jane St. John, M.A.²

Affiliation(s):¹University of North Carolina Wilmington,²Delta Behavioral Health,³Triangle Area Psychology [TAP] Clinic

Abstract:

This lightning round proposal includes a brief description of clinical outcomes from three of our already published manuscripts (Lothes, Mochrie, & St. John, 2014; Lothes et al. 2016 & Mochrie, et al. 2019) examining DBT adapted for a Partial Hospital Program (PHP), two manuscripts currently in submission that report of various outcomes of DBT adapted for both a PHP and Intensive Outpatient (IOP) program, and  preliminary findings of a larger study that examined changes in symptomatology (i.e., Depression, Anxiety, Hopelessness, and Overall Degree of Perceived Suffering) over 5 years of data collected (2013-2017) out of a PHP program in the Southeast United States. This research is highly relevant to a lighting round presentation as there is a dearth of literature examining DBT PHP and IOP programs despite the presence of several prominent clinics in the county. Our results consistently show that when DBT is applied adherently to a PHP or IOP program desired clinical outcomes can be achieved, demonstrating that symptoms of depression, anxiety, hopelessness and suffering all show significant reductions from intake to discharge across a variety of patients. Mochrie et al. (2019) also found that mindfulness scores significantly increased from intake to discharge and accounted for some significant portions of the variance in various symptom scores. Specifically, non-judgmental was a significant predictor in changes in depression and non-reactivity was related to changes in anxiety.

One of the current manuscripts in submission assessed pre-post data to examine changes in symptoms of depression, anxiety, hopelessness, and overall degree of suffering from intake to discharge in both the DBT PHP and IOP programs as well as a step-down condition (PHP to IOP). Participants included 205 adults, ages (M = 35.28, SD = 12.49), predominantly female (N = 139, 67.8%) and Caucasian (N = 181, 88.3%). The sample was divided into three distinct groups: PHP program patients only, PHP to IOP program step-down patients, and IOP patients only. Findings showed significant symptom reduction from intake to discharge within all three groups; however, there were no between-group differences. Interestingly, program type was related to depression symptoms at intake even after controlling for overall hours in treatment; however, it did not predict changes in symptoms from intake to discharge. These DBT PHP and IOP programs were successful at reducing various symptoms in a sample of psychiatric patients. The second manuscript also confirmed that various DBT mindfulness skills are successfully increased when utilizing an adherent model of DBT within this PHP and IOP program.

The 5-year data outcome study (N = 460, F = 328, M = 132) confirmed symptom reductions in clinical symptoms from intake to discharge using a much larger sample and multiple measures of depression/anxiety to increase the validity of previous findings. Moreover, the study also utilized severity ratings to discuss clinical significance in changes of severity from intake to discharge on both depression and anxiety. These outcomes are promising as a potential alternative to inpatient hospitalization as recent research is showing that hospitalization may have iatrogenic effects (Ward-Ciesielski & Rizvi, 2020). Overall treatment implications and effective adaptation/implementation of adherent DBT in PHP and IOP programs will be discussed.