Pilotpētījums par dialektiski biheiviorālās terapijas efektivitāti augsta riska pusaudžiem Bērnu Klīniskās universitātes slimnīcā
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Latvijas Universitāte
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lav
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Puse hospitalizētie un 78% neatliekami stacionētie pusaudži ar paškaitējumu vai suicidālām domām atbilst robežstāvokļa personības traucējumu (RPT) kritērijiem (Guilé et al. 2018). Dialektiski biheiviorālās terapijas (DBT) adaptācija pusaudžiem – DBT-A – ir pierādījusi savu efektivitāti mazinot vēlmi veikt paškaitējumu un pašnāvību (Mehlum et al. 2014), negatīvo emociju intensitāti (Poon et al. 2022) (Geddes et al. 2013) un paškaitējuma biežumu (Syversen et al. 2024) (Kothgassner et al. 2020) jauniešiem ar RPT iezīmēm. Bērnu klīniskajā universitātes slimnīcā DBT-A tika ieviesta 2023. gadā, taču pētījumi par tās efektivitāti nav veikti. Darba mērķis. Izvērtēt DBT-A ietekmi uz vēlmi paškaitēt, lietot atkarību izraisošas vielas, veikt pašnāvību, paškaitējuma, atkarību izraisošo vielu un ārsta izrakstīto medikamentu lietošanas biežumu, kā arī ietekmi uz dažādu emociju intensitāti terapijas gaitā. Materiāli un metodes. Šajā klīniskajā retrospektīvajā pilotpētījumā dati iegūti par pacientiem, kuri ir pabeiguši DBT-A, no iknedēļas DBT-A dienasgrāmatām terapijas sākumā, vidū un beigās. Dati tika apstrādāti ar SPSS 29.0 (IBM Corp.), izmantojot pāru paraugu t-testus un aprēķinot efekta lielumu ar Koena d (d). Rezultāti. Tika apkopoti dati par 15 pusaudžiem (vidējais vecums 15,93 gadi; 86,67% sievietes, N = 13). Vēlme veikt paškaitējumu un pašnāvību, paškaitējuma biežums, prieka intensitāte terapijas gaitā neamainījās (p > 0,05; d < 0,16). Vēlme lietot atkarību izraisošas vielas samazinājās no 2,25 līdz 1,98 terapijas vidū, beigās pieauga līdz 2,26 (p > 0,05; d = 0,29; –0,10). Negatīvo emociju intensitāte terapijas vidū pieauga (sāpju: 2,74 → 2,92; skumju: 2,83 → 3,32; kauna: 1,68 → 2,06; dusmu: 2,36 → 2,59; baiļu: 1,85 → 2,32) (p > 0,05; d = 0,17–0,33). Marihuānas lietošanas biežums sākumā bija 9,14%, vidū 5,03%, beigās 7,55% mēnesī (p > 0,05; d = 0,16; –0,38; 0,07). Alkoholu sākumā lietoja 15,74%, vidū 11,61%, beigās 22,42% mēnesī. Starp terapijas sākumu un vidu lietošana samazinājās (p = 0,253; d = 0,18), starp vidu un beigām pieauga (p = 0,008; d = –0,71). Izrakstīto medikamentu lietošanas biežums mēnesī sākumā bija 71,24%, vidū pieauga līdz 86,62% (p = 0,052; d = –0,47). Starp vidu un beigām, lietošana samazinājās no 87,51% līdz 74,39% mēnesī (p = 0,018; d = 0,6). Secinājumi. Vēlme veikt paškaitējumu un pašnāvību, kopējais vielu, nikotīna lietošanas, paškaitējuma biežums un prieka intensitāte terapijas gaitā nemainījās. DBT-A terapijai uz vēlmi lietot atkarību izraisošas vielas bija mazs efekts, un vēlme uz beigām atgriezās sākotnējā vērtībā. Negatīvo emociju intensitāte vidū pieauga un saglabājās augstāka nekā sākotnēji, kas skaidrojams ar labāku emociju atpazīšanu. Marihuānas un alkohola lietošana samazinājās terapijas vidū, bet pieauga terapijas beigās. Izrakstīto medikamentu lietošanas biežums pieauga, tomēr beigās samazinājās. Pasliktinājums uz terapijas beigām iespējams skaidrojams ar atsitiena efektu un atdalīšanās trauksmi.
Half of hospitalized and 78% of adolescents admitted to emergency room for self-harm and suicidal ideation meet the criteria for borderline personality disorder (BPD) (Guilé et al. 2018). Dialectical Behavior Therapy (DBT) and its adaptation for adolescents (DBT-A) has demonstrated efficacy in reducing self-harm urges and suicidal ideation (Mehlum et al. 2014), lowering the intensity of negative emotions (Poon et al. 2022) (Geddes et al. 2013), and decreasing frequency of self-harm (Syversen et al. 2024) (Kothgassner et al. 2020). In Latvia, the DBT-A program at the Children’s Clinical University Hospital (CCUH) was introduced in 2023, yet its effectiveness remains unexplored. Aim. To access the effects of DBT-A on urges to use substances, self-harm and commit suicide, the instensity of various emotions during therapy, and the frequency of self-harm, substance abuse and use of prescribed medications. Materials and methods. In this retrospective clinical pilotstudy, data was retrieved from CCUH archives for patients who completed DBT-A – from weekly DBT-A diary entries at the beginning, midpoint and the end of therapy. Data analysis was performed in SPSS 29.0 (IBM Corp.) using paired samples t-tests and effect sizes were measured using Cohen’s d (d). Results. Fifteen adolescents (mean age 15.93 years; 86.67% female, N = 13) were included. Urge to self-harm, suicidal ideation, joy, frequency of self-harm, overall substance and nicotine use did not differ across time points (p > 0.05; d < 0.16). Mean substance-use urges decreased from 2.25 to 1.98 at midpoint, then returned to 2.26 (p > 0.05; d = 0.29; –0.10). Negative-emotion intensities rose at midpoint (pain: 2.74 → 2.92; sadness: 2.83→3.32; shame: 1.68 → 2.06; anger: 2.36 → 2.59; fear: 1.85 →2.32) (p > 0,05; d = 0.17–0.33). Monthly marijuana use was 9.14%, 5.03%, and 7.55% (d = 0.16; –0.38; 0.07). Alcohol use fell from 15.74% to 11.61% at midpoint (p = 0,253; d = 0,18) then rose to 22.42% at the end (p = 0.008; d = –0.71). Prescribed-medication adherence rose from 71.24% to 86.62% at midpoint (p = 0.052; d = –0.47) then declined to 74.39% at the end (p = 0.018; d = 0.60). Conclusions. The urge to self-harm, suicidal ideation, intensity of joy, frequency of overall substance and nicotine use and self-harm remained unchanged over the course of therapy. DBT-A had a small effect on the urge to use substances, but it returned to it’s baseline by end of treatment. Negative-emotion intensity rose at midpoint and stayed higher than at baseline, likely reflecting improved emotion recognition. Marijuana and alcohol use both decreased mid-therapy but then increased at the end. Prescribed medication adherence rose at the middle of therapy, but then declined by the end. This regression at the end may be explained by the rebound effect and separation anxiety. When interpreting these findings, it’s important to remember that the small sample size limited statistical power.
Half of hospitalized and 78% of adolescents admitted to emergency room for self-harm and suicidal ideation meet the criteria for borderline personality disorder (BPD) (Guilé et al. 2018). Dialectical Behavior Therapy (DBT) and its adaptation for adolescents (DBT-A) has demonstrated efficacy in reducing self-harm urges and suicidal ideation (Mehlum et al. 2014), lowering the intensity of negative emotions (Poon et al. 2022) (Geddes et al. 2013), and decreasing frequency of self-harm (Syversen et al. 2024) (Kothgassner et al. 2020). In Latvia, the DBT-A program at the Children’s Clinical University Hospital (CCUH) was introduced in 2023, yet its effectiveness remains unexplored. Aim. To access the effects of DBT-A on urges to use substances, self-harm and commit suicide, the instensity of various emotions during therapy, and the frequency of self-harm, substance abuse and use of prescribed medications. Materials and methods. In this retrospective clinical pilotstudy, data was retrieved from CCUH archives for patients who completed DBT-A – from weekly DBT-A diary entries at the beginning, midpoint and the end of therapy. Data analysis was performed in SPSS 29.0 (IBM Corp.) using paired samples t-tests and effect sizes were measured using Cohen’s d (d). Results. Fifteen adolescents (mean age 15.93 years; 86.67% female, N = 13) were included. Urge to self-harm, suicidal ideation, joy, frequency of self-harm, overall substance and nicotine use did not differ across time points (p > 0.05; d < 0.16). Mean substance-use urges decreased from 2.25 to 1.98 at midpoint, then returned to 2.26 (p > 0.05; d = 0.29; –0.10). Negative-emotion intensities rose at midpoint (pain: 2.74 → 2.92; sadness: 2.83→3.32; shame: 1.68 → 2.06; anger: 2.36 → 2.59; fear: 1.85 →2.32) (p > 0,05; d = 0.17–0.33). Monthly marijuana use was 9.14%, 5.03%, and 7.55% (d = 0.16; –0.38; 0.07). Alcohol use fell from 15.74% to 11.61% at midpoint (p = 0,253; d = 0,18) then rose to 22.42% at the end (p = 0.008; d = –0.71). Prescribed-medication adherence rose from 71.24% to 86.62% at midpoint (p = 0.052; d = –0.47) then declined to 74.39% at the end (p = 0.018; d = 0.60). Conclusions. The urge to self-harm, suicidal ideation, intensity of joy, frequency of overall substance and nicotine use and self-harm remained unchanged over the course of therapy. DBT-A had a small effect on the urge to use substances, but it returned to it’s baseline by end of treatment. Negative-emotion intensity rose at midpoint and stayed higher than at baseline, likely reflecting improved emotion recognition. Marijuana and alcohol use both decreased mid-therapy but then increased at the end. Prescribed medication adherence rose at the middle of therapy, but then declined by the end. This regression at the end may be explained by the rebound effect and separation anxiety. When interpreting these findings, it’s important to remember that the small sample size limited statistical power.