The Effectiveness of Dialectical Behaviour Therapy (DBT) in Dealing with Posttraumatic Stress Disorder (PTSD) Among Teenagers: A Single Case Study
DOI:
https://doi.org/10.33102/abqari.vol31no1.622Keywords:
PTSD, DBT, bullying, self-esteem, self-harm.Abstract
Introduction: Bullying is a traumatic event which has negative consequences on adolescents' mental health. A likely consequence is posttraumatic stress disorder (PTSD). Objective: The study had two objectives: (a) to measure the level of trauma and (b) to see the effectiveness of dialectical behaviour therapy (DBT) as an intervention for teenagers with PTSD. Methodology: The participant was a 15-year-old Malay female teenager from a boarding school, who completed a PCL-5 instrument to determine the level of trauma. A descriptive methodology was applied to answer the first objective while thematic analysis was utilised for the second objective. The adopted methodology of this research was a mixed method, quasi-experimental design using PCL-5 for the instrument and in-depth interviews for qualitative data. There were six sessions held by the mental health practitioner to assess the effectiveness of DBT in dealing with the teenager with PTSD. Results: The results confirm that (a) the percentage of victims of PTSD and bullying was significantly higher and needed an intervention by a mental health practitioner, and (b) the victim had suffered significantly with trauma that led to low self-esteem, self-harm, and suicide attempt. The result further indicated that DBT techniques using mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness showed significantly improved effectiveness in helping the victim cure the symptoms related to PTSD. Discussion: The study emphasised the importance of intervention from family, school, and society at large to reduce bullying and enhance respect for sexual diversity which is discussed as an effective tool to help the victims of PTSD.
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References
Alisic, E., Zalta, A. K., van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid, G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry, 204(5), 335–340. https://doi.org/10.1192/bjp.bp.113.131227
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, D.C.: American Psychiatric Association.
Arseneault, L., Bowes, L., & Shakoor, S. (2010). Bullying victimization in youths and mental health problems: 'Much ado about nothing'? Psychological Medicine, 40(5), 717–729. https://doi.org/10.1017/S0033291709991383
Ary, D., Jacobs, L. C., & Razavieh, A. (2002). Introduction to research in education (6th ed.). Belmont, CA: Wadsworth Thomson Learning.
Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., … Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: A randomized clinical trial. JAMA Psychiatry, 77(12), 1235–1245. https://doi.org/10.1001/jamapsychiatry.2020.2148
Bohus, M., & Priebe, K. (2019). DBT for PTSD: A treatment programme for complex PTSD after childhood abuse. In M. A. Swales (Ed.), The Oxford handbook of dialectical behaviour therapy (pp. 815–828). Oxford University Press.
Bohus, M., Schmahl, C., Fydrich, T., Steil, R., Müller-Engelmann, M., Herzog, J., … Priebe, K. (2019). A research programme to evaluate DBT-PTSD, a modular treatment approach for complex PTSD after childhood abuse. Borderline Personality Disorder and Emotion Dysregulation, 6, Article 7. https://doi.org/10.1186/s40479-019-0099-y
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Bryman, A. (2008). Social research methods (3rd ed.). New York: Oxford University Press.
Carlisle, N., & Rofes, E. (2007). School bullying: Do adult survivors perceive long-term effects? Traumatology, 13(1), 16–26. https://doi.org/10.1177/1534765607299911
Cisler, J. M., & Herringa, R. J. (2021). Posttraumatic stress disorder and the developing adolescent brain. Biological Psychiatry, 89(2), 144–151. https://doi.org/10.1016/j.biopsych.2020.06.001
Cohen, L., Manion, L., & Morrison, K. (2011). Research methods in education (7th ed.). London: Routledge. https://doi.org/10.4324/9780203720967
DeRosa, R. R., Amaya-Jackson, L., & Layne, C. M. (2013). From rifts to riffs: Evidence-based principles to guide critical thinking about next-generation child trauma treatments and training. Training and Education in Professional Psychology, 7(3), 195–204. https://doi.org/10.1037/a0033086
Fasulo, S. J., Ball, J. M., Jurkovic, G. J., & Miller, A. L. (2015). Towards the development of an effective working alliance: The application of DBT validation and stylistic strategies in the adaptation of a manualized complex trauma group treatment program for adolescents in long-term detention. The American Journal of Psychotherapy, 69(2), 219–239. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.219
Fitzpatrick, S., Bailey, K., & Rizvi, S. L. (2020). Changes in emotions over the course of dialectical behavior therapy and the moderating role of depression, anxiety, and posttraumatic stress disorder. Behavior Therapy, 51(6), 946–957. https://doi.org/10.1016/j.beth.2019.12.009
Flynn D., Joyce M., Weihrauch M., Corcoran P. (2018). Innovations in Practice: Dialectical behaviour therapy - skills training for emotional problem solving for adolescents (DBT STEPS-A): evaluation of a pilot implementation in Irish postprimary schools. Child and Adolescent Mental Health, 23(4), 376-380.
Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., & Yeh, R. (2018). Psychometrics of the Child PTSD Symptom Scale for DSM-5 for trauma-exposed children and adolescents. Journal of Clinical Child & Adolescent Psychology, 47(1), 38–46. https://doi.org/10.1080/15374416.2017.1350962
Folk, J. B., Yang, P., Thomas, A., Lyon, J., Patel, J., Yoon, C., & Robles-Ramamurthy, Barbara. (2023). Comprehensive dialectical behavior therapy for adolescents in a juvenile correctional treatment center: A pilot evaluation. Frontiers in Child and Adolescent Psychiatry, 2. https://doi.org/10.3389/frcha.2023.1207575
Geddes, K., Dziurawiec, S., & Lee, C. W. (2013). Dialectical behaviour therapy for the treatment of emotion dysregulation and trauma symptoms in self-injurious and suicidal adolescent females: A pilot programme within a community-based child and adolescent mental health service. Psychiatry Journal, 2013, Article 145219. https://doi.org/10.1155/2013/145219
Giedd, J. N. (2008). The teen brain: Insights from neuroimaging. Journal of Adolescent Health, 42(4), 335–343. https://doi.org/10.1016/j.jadohealth.2008.01.007
Gillespie, C., Murphy, M., Kells, M., & Flynn, D. (2022). Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of processes and experiences at long-term follow-up. Borderline personality disorder and emotion dysregulation, 9(1), 8. https://doi.org/10.1186/s40479-022-00179-9
Görg, N., Priebe, K., Böhnke, J. R., Steil, R., Dyer, A. S., & Kleindienst, N. (2017). Trauma-related emotions and radical acceptance in dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse. Borderline Personality Disorder and Emotion Dysregulation, 4, Article 15. https://doi.org/10.1186/s40479-017-0065-5
Granato, H. F., Wilks, C. R., Miga, E. M., Korslund, K. E., & Linehan, M. M. (2015). The use of dialectical behavior therapy and prolonged exposure to treat comorbid dissociation and self-harm: The case of a client with borderline personality disorder and posttraumatic stress disorder. Journal of Clinical Psychology, 71(8), 805–815. https://doi.org/10.1002/jclp.22207
Gutermann, J., Schwartzkopff, L., & Steil, R. (2017). Meta-analysis of the long-term treatment effects of psychological interventions in youth with PTSD symptoms. Clinical Child and Family Psychology Review, 20, 422–434. https://doi.org/10.1007/s10567-017-0242-5
Harned, M. S., Jackson, S. C., Comtois, K. A., & Linehan, M. M. (2010). Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self-injuring women with borderline personality disorder. Journal of Traumatic Stress, 23(4), 421–429. https://doi.org/10.1002/jts.20553
Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol. Behaviour Research and Therapy, 50(6), 381–386. https://doi.org/10.1016/j.brat.2012.02.011
Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialetical Behavior Therapy Prolonged Exposure Protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7–17. https://doi.org/10.1016/j.brat.2014.01.008
Hu, N., Taylor, C. L., Li, J., & Glauert, R. A. (2017). The impact of child maltreatment on the risk of deliberate self-harm among adolescents: A population-wide cohort study using linked administrative records. Child Abuse & Neglect, 67, 322–337. https://doi.org/10.1016/j.chiabu.2017.03.012
Idsoe, T., Dyregrov, A., & Idsoe, E. C. (2012). Bullying and PTSD symptoms. Journal of Abnormal Child Psychology, 40(6), 901–911. https://doi.org/10.1007/s10802-012-9620-0
Keng, S.-L., Mohd Salleh Sahimi, H., Chan, L. F., Woon, L., Eu, C. L., Sim, S. H., & Wong, M. K. (2021). Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: Feasibility, acceptability, and preliminary outcomes. BMC Psychiatry, 21, Article 486. https://doi.org/10.1186/s12888-021-03500-y
Kleindienst, N., Steil, R., Priebe, K., Müller-Engelmann, M., Biermann, M., Fydrich, T., Schmahl, C., & Bohus, M. (2021). Treating adults with a dual diagnosis of borderline personality disorder and posttraumatic stress disorder related to childhood abuse: Results from a randomized clinical trial. Journal of Consulting and Clinical Psychology, 89(11), 925–936. https://doi.org/10.1037/ccp0000687
Matthieson, S. B., & Einarsen, S. (2004). Psychiatric distress and symptoms of PTSD among victims of bullying at work. British Journal of Guidance & Counselling, 32(3), 335–356. https://doi.org/10.1080/03069880410001723558
Mckenney, K. S., Pepler, D. J., Craig, W. M., & Connolly, J. A. (2005). Psychosocial consequences of peer victimization in elementary and high school – an examination of posttraumatic stress disorder symptomatology. In K. A. Kendall-Tackett & S. M. Giacomoni (Eds.), Child victimization: Maltreatment, bullying and dating violence, prevention and intervention (pp. 15–17). Kingston, NJ: Civic Research Institute.
Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017
Merriam, S. B. (1998). Qualitative research and case study applications in education: Revised and expanded from case study research in education. San Francisco, CA: Jossey-Bass Publishers.
Middlebrooks, J. S., & Audage, N. C. (2008). The effects of childhood stress on health across the lifespan. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. http://stacks.cdc.gov/view/cdc/6978
Mutch, C. (2005). Doing educational research: A practitioner's guide to getting started. Wellington: New Zealand Council for Educational Research (NZCER).
Mynard, H., Joseph, S., & Alexander, J. (2000). Peer-victimisation and posttraumatic stress in adolescents. Personality and Individual Differences, 29(5), 815–821. https://doi.org/10.1016/S0191-8869(99)00234-2
Nazir, S., Kazmi, S. F., & Dil, S. (2023). Application of dialectical behaviour therapy with CSA related PTSD among young adolescents. Pakistan Journal of Social Sciences, 43(4), 597–606. https://doi.org/10.5281/zenodo.10448510
Nielsen, M. B., Tangen, T., Idsoe, T., Matthiesen, S. B., & Magerøy, N. (2015). Post-traumatic stress disorder as a consequence of bullying at work and at school. A literature review and meta-analysis. Aggression and Violent Behavior, 21, 17–24. https://doi.org/10.1016/j.avb.2015.01.001
Oppenauer, C., Sprung, M., Gradl, S., & Burghardt, J. (2023). Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): Transportability to everyday clinical care in a residential mental health centre. European Journal of Psychotraumatology, 14(1), Article 2157159. https://doi.org/10.1080/20008066.2022.2157159
Plexousakis, S. S., Kourkoutas, E., Giovazolias, T., Chatira, K., & Nikolopoulos, D. (2019). School bullying and post-traumatic stress disorder symptoms: The role of parental bonding. Frontiers in Public Health, 7, Article 75. https://doi.org/10.3389/fpubh.2019.00075
Punch, K. F. (2009). Introduction to research methods in education. London: SAGE Publications.
Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., Ostrowski, S. A., & Fairbank, J. A. (2009). DSM-V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22(5), 391–398. https://doi.org/10.1002/jts.20450
Rivers, I. (2004). Recollections of bullying at school and their long-term implications for lesbians, gay men and bisexuals. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 25(4), 169–175. https://doi.org/10.1027/0227-5910.25.4.169
Schnurr PP, Friedman MJ, Bernardy NC. Research on posttraumatic stress disorder: Epidemiology, pathophysiology, and assessment. Journal of Clinical Psychology. 2002;58(8):877-889
Sprang, G., & Silman, M. (2013). Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Medicine and Public Health Preparedness, 7(1), 105–110. https://doi.org/10.1017/dmp.2013.22
Steil, R., Dittmann, C., Müller-Engelmann, M., Dyer, A., Maasch, A.-M., & Priebe, K. (2018). Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study in an outpatient treatment setting. European Journal of Psychotraumatology, 9(1), Article 1423832. https://doi.org/10.1080/20008198.2018.1423832
Steil, R., Schneider, A., & Schwartzkopff, L. (2021). How to treat childhood sexual abuse related PTSD accompanied by risky sexual behavior: A case study on the use of dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD). Journal of Child & Adolescent Trauma, 15(2), 471–478. 10.1007/s40653-021-00421-6.
Tanvir, Z., Bokhari, M. Z., Kareem, R., & Butt, M. G. (2023). The effectiveness of BDT compared to other psychological therapies in patients with a dual diagnosis of PTSD and BPD: A systematic review. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1121–1133. https://jptcp.com/index.php/jptcp/article/view/3245
Wamser-Nanney, R., & Steinzor, C. E. (2017). Factors related to attrition from trauma-focused cognitive behavioral therapy. Child Abuse & Neglect, 66, 73–83. https://doi.org/10.1016/j.chiabu.2016.11.031
World Health Organization (WHO). (2022, June 8). Fact sheets: Mental disorders. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-disorders
Xiao, C. (2022). Efficacy and risk factor analysis of DBT therapy for PTSD-related symptoms in mainland Chinese college students based on data mining. Computational Intelligence and Neuroscience, 2022, Article 3829623. https://doi.org/10.1155/2022/3829623
Yin, R. K. (1994). Case study research: Design and methods (2nd ed.). Thousand Oaks, CA: SAGE Publications.
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