title: Dialectical behavior therapy in an intensive outpatient program with a mixed-diagnostic sample.
abstract: OBJECTIVE
  Intensive outpatient programs (IOPs) have become increasingly common for treating highly distressed patients, and a burgeoning number of IOPs are based on, or informed by, dialectical behavior therapy (DBT). The goal of the present study was to evaluate the effectiveness of DBT in a community mental health center IOP for patients with heterogeneous diagnoses.
  
  
  METHODS
  Using a within-subjects design, we examined changes in depression, anxiety, mindfulness, and hope during DBT treatment in a community mental health center in the Midwestern United States. The final sample comprised 56 participants (59% female) ranging in age from 18 to 73 years, with a mean age of 36.8 years (standard deviation = 13.7). The majority of participants (80%) met criteria for a mood disorder, just over half met criteria for an anxiety disorder, and 20% met criteria for comorbid substance abuse or dependence. Over half met criteria for more than one diagnosis. Length of treatment varied based on the needs of the individual patient; treatment ranged from 2 to 16 weeks, with an average stay of 6 weeks.
  
  
  RESULTS
  Depression and anxiety scores decreased significantly and hope scores increased significantly over the course of treatment (all p's < .001). Mindfulness scores did not increase significantly, although changes did occur in the predicted direction. In addition, the extent to which hope and mindfulness increased over the course of treatment predicted final depression and anxiety scores after controlling for baseline symptom levels.
  
  
  CONCLUSIONS
  Results suggest that this DBT-informed intervention was effective in reducing depression and anxiety and increasing hope. Because of the move away from inpatient hospitalizations over the last few decades, it is incumbent on the field to find alternative ways to treat patients in need of more acute, intensive care. Moreover, these treatments must be cost effective, as many of these patients have limited financial resources. Group therapy formats might provide an appropriate and needed bridge for this coverage gap. The results of this study suggest that a DBT-informed IOP might be an amenable treatment for this population.
authors.affiliation: Emory University School of Medicine, Department of Psychiatryand Behavioral Sciences, Atlanta, GA 30306, USA. lorie.ritschel@emory.edu
authors.forename: Lorie A
authors.initials: LA
authors.lastname: Ritschel
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Cheavens
authors.forename: Juliet
authors.initials: J
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods*; D003155:Community Mental Health Centers; D003863:Depression / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy; D055815:Young Adult