Re: differential mechanism

The study I referred to is not a DBT study per se but is an open label trial (no control group) that involved clients that were undergoing DBT treatment. Dissociative symptoms such as tonic immobility, as well as PTSD specific symptoms such as flashbacks were reported. The reference is Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Bohme R, Schmahl CG (1999). Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry , 60, 598-603.

Generally, rearding DBT, I am not sure whether it commonly reduces either fear or anxiety. It does appear to reduce affect dysregulation and increase affect tolerance and as such appears to be one of the treatments of choice in complex PTSD as a preliminary step before doing trauma centered treatment. It should be noted that there is a significant overlap between complex PTSD/DESNOS and Borderline Personality Disorder.

Generally, Bohus et al provide as rationale for their naltrexone study that excessive dissociative symptoms interfere with psychotherapy such as DBT, and from a clinical point of view that certainly makes sense. If their naltrexone treated patients have less dissociative and PTSD symptoms without exposure treatment, that certainly raises the question as to the possibility of a differential mechanism of DBT and exposure as well. E.g., naltrexone appears to interfere with exposure treatment . However, exposure treatment subsequent to DBT has also been shown to reduce dissociative symptoms, whereas DBT alone does not appear to reduce dissociation.

I'll try to address some of the other points in future posts.

Replies:

Re: differential mechanism, by Cahill, 11/06/01 Re: differential mechanism, by Ulrich Lanius, 11/07/01 Re: differential mechanism, by Cahill, 11/07/01

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