Yale University School of Medicine, New Haven, Connecticut, USA.
James J. Peters VA Medical Center, VISN 2 MIRECC, Bronx, New York, USA.
Psychol Psychother. 2021 Sep;94(3):504-522. doi: 10.1111/papt.12325. Epub 2021 Mar 27.
Dialectical behaviour therapy (DBT) emphasizes generalization of skills to the patient's real-world context as a primary mechanism of change in treatment. To promote generalization, DBT includes weekly skills-focused homework assignments and as-needed phone coaching. Despite this central function of generalization in DBT, research on these treatment components is limited. The current study addresses this research gap by assessing the association of homework and phone coaching to DBT treatment outcomes.
A longitudinal study design explored the extent to which (a) completion of skills homework and (b) frequency of phone coaching were associated with therapeutic changes and treatment outcomes in a DBT intensive outpatient programme (DBT-IOP).
Medical records and diary cards of 56 patients who had completed a four-month treatment cycle of DBT-IOP were reviewed and coded for proportion of skills homework completed, frequency of phone coaching calls, and reported urges for and engagement in suicide, non-suicidal self-injury, illicit or non-prescribed substance use, and alcohol use behaviours.
Completion of skills homework and frequency of phone coaching were significantly associated with (a) reduced urges for suicide, non-suicidal self-injury, illicit or non-prescribed substance use, and alcohol use from the beginning to end of treatment and (b) a lower likelihood of engaging in any of these behaviours during the final month of treatment.
Results suggest that within a DBT programme modified for an intensive outpatient setting, skills homework and phone coaching may enhance therapeutic change and outcomes in target behaviours. These generalization methods appear to be important ingredients of DBT effectiveness.
In dialectical behaviour therapy (DBT), therapeutic skills homework and phone coaching are specifically designed to promote generalization of skills from the therapeutic context to the patient's real-world contexts. In a DBT intensive outpatient programme, patient engagement with therapeutic homework and phone coaching were associated with favourable therapeutic change and outcomes in target urges and behaviours. Clinicians may consider a patient's lack of homework completion and/or phone coaching to be early warning signs of poor therapeutic progress within dialectical behaviour therapy.
辩证行为疗法（DBT）强调将技能推广到患者的现实世界环境中，作为治疗中改变的主要机制。为了促进推广，DBT 包括每周以技能为重点的家庭作业和按需电话辅导。尽管 DBT 的推广是其核心功能之一，但关于这些治疗成分的研究有限。本研究通过评估家庭作业和电话辅导与 DBT 治疗结果的关联，解决了这一研究空白。
一项纵向研究设计探讨了在 DBT 强化门诊计划（DBT-IOP）中，（a）完成技能作业和（b）电话辅导频率与治疗变化和治疗结果之间的关联程度。
对完成了为期四个月的 DBT-IOP 治疗周期的 56 名患者的医疗记录和日记卡进行了回顾和编码，以评估完成技能作业的比例、电话辅导电话的频率、报告的自杀冲动、非自杀性自伤、非法或非处方药物使用以及酒精使用行为的冲动和参与情况。
完成技能作业和电话辅导的频率与（a）从治疗开始到结束时自杀、非自杀性自伤、非法或非处方药物使用和酒精使用冲动的减少，以及（b）在治疗的最后一个月内任何这些行为的发生可能性降低显著相关。
结果表明，在为强化门诊环境修改的 DBT 计划中，技能作业和电话辅导可能会增强治疗变化和目标行为的治疗结果。这些推广方法似乎是 DBT 有效性的重要组成部分。
在辩证行为疗法（DBT）中，治疗技能作业和电话辅导专门设计用于促进技能从治疗环境推广到患者的现实世界环境。在 DBT 强化门诊计划中，患者对治疗性家庭作业和电话辅导的参与与目标冲动和行为的有利治疗变化和结果相关。临床医生可能会将患者缺乏家庭作业完成和/或电话辅导视为 DBT 中治疗进展不佳的早期预警信号。
