Traitements spécialisés des personnes ayant des problèmes concomitants de santé mentale et toxicomanie : un modèle intégrant la thérapie dialectique comportementale

Cet article décrit un programme de traitements intégrés pour personnes ayant des troubles comorbides de santé mentale et de toxicomanie. La thérapie dialectique comportementale (TDC) a été développée à l'origine par Linehan (l993a ; 1993b) à l'intention des individus souffrant de troubles de personnalité limite et chroniquement suicidaires. Ses principes ont fourni le cadre pour l'organisation d'un programme de traitements spécialisés dans les domaines suivants : toxicomanie et trouble de personnalité limite, troubles liés aux substances et colère, et troubles liés aux substances et troubles alimentaires. Un aperçu de la TDC et les raisons qui appuient un programme concomitant basé sur cette approche sont discutés. On décrit les protocoles pour trois sous-groupes de patients, en portant une attention particulière aux similitudes et aux différences avec le protocole standard de la TDC. Les éléments principaux du programme sont soulignés.Specialized treatment for individuals with co-occuring mental health and substance use disorders : a model for integrating dialectical behaviour therapy This article describes an integrated treatment program for individuals with concurrent mental health and substance use disorders. Principles of dialectical behaviour therapy (DBT), originally developed by Linehan (l993a ; 1993b) for chronically suicidal individuals with borderline personality disorder, provided the framework for the organization of a program of specialized treatment services in the following areas ; substance use and borderline personality disorder, substance use and anger, and substance use and eating disorders. An overview of DBT and the rationale for founding a concurrent disorder program upon this approach is discussed. A description of our treatment protocols for the three subgroups of concurrent disordered patients is provided with attention to the similarities and differences from the standard DBT protocol. The principal elements of the program are highlighted.Tratamiento especialisado para indivduos con coacontecimiento de desordenes de salud mental y de abuso de sustancias: un modelo para integrar la terapia dialectica behavioral Este artículo describe un programa de tratamiento integrado para individuos con un coacontecimiento de desordenes de salud mental y uso de sustancia. Principios de la terapia dialectica behavioral (DBT), desarrollada por Linehan (1993a; 1993b) para individuos crónicamente suicida con un desorden de personalidad límite (borderline) constituye el cuadro para la organisación de un programa de servicios especialisados en los campos siguientes: uso de sustancia y desorden de personalidad límite, uso de sustancia y cólera, uso de sustancia y turbios alimentarios. Un sobrevuelto del DBT y la racionalización para fundar un programa conjunto de desordenes basado sobre esta aproximación esta discutido. Una descripción del protocolo de tratamiento por los tres subgrupos de patientes con desordenes esta dado con una atención a las similitudes y diferencias del protocolo estándar DBT. Elementos del progama estan subrayados

Future Challenges in Psychotherapy Research for Personality Disorders

Purpose of Review Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Recent Findings Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. Summary We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy

Contrasting Clients in Dialectical Behavior Therapy for Borderline Personality Disorder: "Marie" and "Dean," Two Cases with Different Alliance Trajectories & Outcomes

Dialectical Behavior Therapy (DBT; Linehan, 1993a) has garnered a strong evidence base to support its efficacy in treating borderline personality disorder (BPD). Despite this, some clients do not benefit from evidenced-based approaches. There is a recent emphasis on identifying the processes and mechanisms of DBT in order to improve treatment outcomes. This report describes the course of treatment for two individuals who were treated with one-year of standard, outpatient DBT in the context of a randomized control trial. The two clients were selected because (1) both reported poor initial alliances, and (2) they had different outcomes. The first case, "Marie," showed considerable change across a broad range of outcomes whereas the second case, "Dean," made only limited treatment gains. The two cases are contrasted in order to highlight potential factors that may have contributed to the different alliance trajectories and outcomes. We explore several hypotheses to help to explain the relationship between treatment outcome and client characteristics, the therapeutic alliance, the consultation team, and the research context

Treatment Selection in Borderline Personality Disorder

Comprehensive moderator analysis and estimation of benefit from treatment selection based on combined moderators, from a trial comparing dialectical-behavioral therapy and good psychodynamic psychiatric management for borderline personality disorde