Skip to main content

Advertisement

Log in

Utilization of Evidenced Based Dialectical Behavioral Therapy in Assertive Community Treatment: Examining Feasibility and Challenges

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Assertive Community Treatment (ACT) programs have been treating individuals with chronic and severe mental illness since the 1970s. While ACT programs were developed to address the treatment needs of severely mentally ill persons traditionally suffering from chronic mental illnesses, ACT programs are seeing a growing number of persons with co-morbid personality disorders. The efficacy of traditional ACT programs in treating individuals with co-occurring personality disorders is uncertain, in particular individuals with co-morbid Borderline Personality Disorder (BPD). Dialectical Behavior Therapy (DBT) has been proposed as an effective approach to treating clients with BPD in this setting. The purpose of this paper is to examine the value of DBT for individuals with BPD in ACT programs. The writers discuss the prevalence of Borderline Personality Disorders in ACT populations, briefly review the literature on DBT in ACT, address the feasibility of implementing DBT in an ACT model, examine potential barriers to this implementation, and highlight potential areas for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aarons, G. A. (2004). Mental health providers’ attitudes toward adoption of evidenced-based practices: The evidenced-based practice attitude scale (EBPAS). Mental Health Services Research, 6(2), 61–74.

    Article  PubMed  Google Scholar 

  • Aarons, G. A., & Palinkas, L. A. (2007). Implementation of evidenced based practice in child welfare: Service provider prospective. Administration and Police in Mental Health & Mental Health Services Research, 34, 411–419.

    Article  Google Scholar 

  • Adams, N., & Grieder, D. M. (2005). Treatment planning for person-centered care: The road to mental health and addiction recovery. Burlington, MA: Elsevier Academic Press.

    Google Scholar 

  • Allness, D., & Knoedler, W. (2003). National Program Standards for ACT Teams. Arlington, VA: National Alliance for the Mentally Ill.

  • Behavioral Tech LLC. (2011). http://behavioraltech.org/index.cfm?CFID=50019016&CFTOKEN=76195969. Accessed 19 Dec 2011.

  • Black, D., Blum, N., Pfohl, B., & Hale, N. (2004). Suicidal behavior in borderline personality disorder: Prevalence, risk factors, predictions, and prevention. Journal of Personality Disorders, 18(3), 226–239.

    Article  PubMed  Google Scholar 

  • Bohus, M., Haaf, B., Stiglmayer, C., Pohl, U., Boehme, R., & Linehan, M. (2000). Evaluation of inpatient dialectical behavior therapy for borderline personality disorder—A prospective study. Behavior Research and Therapy, 38(9), 875–887.

    Article  CAS  Google Scholar 

  • Bond, G., Drake, R., Mueser, K., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Manage Health Outcomes, 9(3), 141–159.

    Article  Google Scholar 

  • Bond, G. R., Witheridge, T. F., Dincin, J., Wasmer, D., Webb, J., & De Graaf-Kaser, R. (1990). Assertive community treatment for frequent users of psychiatric hospitals in a large city: A controlled study. American Journal of Community Psychology, 18, 865–891.

    Article  PubMed  CAS  Google Scholar 

  • Borland, A., McRae, J., & Lycan, C. (1989). Outcomes of five years of continuous intensive case management. Hospital & Community Psychiatry, 40, 369–376.

    CAS  Google Scholar 

  • Burns, T. (2010). The rise and fall of assertive community treatment? International Review of Psychiatry, 22(2), 130–137.

    Article  PubMed  Google Scholar 

  • Corrigan, P. W. (1994). Differences between clinical and nursing inpatient staff: Implications for training in behavioral rehabilitation. Journal of Behavioral Therapy and Experimental Psychiatry, 25, 311–316.

    Article  CAS  Google Scholar 

  • Corrigan, P. W., McCracken, S. G., Kommana, S., Edwards, M., & Simpatico, T. (1997). Changing staff attitudes about behavioral rehabilitation programs. Psychiatric Services, 48, 1336–1338.

    PubMed  CAS  Google Scholar 

  • Corrigan, P. W., Steiner, L., McCracken, S. G., Blaser, B., & Barr, M. (2001). Strategies for disseminating evidence-based practices to staff who treat people with serious mental illness. Psychiatric Services, 52(12), 1598–1606.

    Article  PubMed  CAS  Google Scholar 

  • Cunningham, K., Wolbert, R., & Lillie, B. (2004). It’s about me solving my problems: Clients’ assessments of dialectical behavior therapy. Cognitive and Behavioral Practice., 11, 248–256.

    Article  Google Scholar 

  • Davidson, D. (1999). Assertive outreach: Making sense of models. Mental Health Review, 4, 20–23.

    Article  Google Scholar 

  • Deegan, P. (1997). Recovery and empowerment for people with psychiatric disabilities. Social Work in Mental Health Care, 25(3), 11–24.

    Article  CAS  Google Scholar 

  • Dewe, C., & Krawitz, R. (2007). Component analysis of dialectical behavior therapy skills training. Australasian Psychiatry, 15(3), 222–225.

    Article  PubMed  Google Scholar 

  • Dimeff, L. A., & Koerner, K. (2007). Dialectical behavior therapy in clinical practice: applications across disorders and settings. New York: The Guilford Press.

  • Donat, D., & McKeegan, G. (1997). Behavioral knowledge and occupational stress among inpatient psychiatric caregivers. Psychiatric Rehabilitation Journal, 21, 67–69.

    Google Scholar 

  • Drake, R. E. (1998). Brief history, current status, and future place of assertive community treatment. American Journal of Orthopsychiatry, 68(2), 172–175.

    Article  PubMed  CAS  Google Scholar 

  • Drake, R. E., & Deegan, P. E. (2008). Are assertive community treatment and recovery compatible? Commentary on “ACT and recovery: Integrating evidenced-based practices and recovery orientation on assertive community treatment teams”. Community Mental Health Journal, 44, 75–77.

    Article  PubMed  Google Scholar 

  • Essock, S. M., Goldman, H. H., Van Tosh, L., Anthony, W. A., Appell, C. R., Bond, G. R., et al. (2003). Evidence-based practices: Setting the context and responding to concerns. Psychiatric Clinics of North America, 26, 919–938.

    Article  PubMed  Google Scholar 

  • Feigenbaum, J. (2007). Dialectical behavior therapy: An increasing evidence base. Journal of Mental Health, 16(1), 51–68.

    Article  Google Scholar 

  • Geller, J. L. (1986). In again, out again: Preliminary evaluation of a state hospital’s worst recidivists. Hospital & Community Psychiatry, 37, 386–390.

    CAS  Google Scholar 

  • Gold Award. (1998). Integrating dialectical behavioral therapy into a community mental health program: The Mental Health Center of Greater Manchester. New Hampshire Psychiatric Services, 49, 1338–1340.

    Google Scholar 

  • Herschell, A. D., Kogan, J. N., Celedonia, K. L., Gavin, J. G., & Stein, B. D. (2009). Understanding community mental health administrators’ perspectives on dialectical behavior therapy implementation. Psychiatric Services, 60, 989–992.

    Article  PubMed  Google Scholar 

  • Hesslinger, B., Tebartz van Elst, L., Nyberg, E., Dykierek, P., Richter, H., Berner, M., et al. (2002). Psychotherapy of attention deficit hyperactivity disorder in adults: A pilot study using a structured skills training program. European Archives of Psychiatry and Clinical Neuroscience, 252, 117–184.

    Google Scholar 

  • Horvitz-Lennon, M., Reynolds, S., Wolbert, R., & Witheridge, T. (2009). The role of assertive community treatment in the treatment of people with borderline personality disorder. American Journal of Psychiatric Rehabilitation, 12, 261–277.

    Article  PubMed  Google Scholar 

  • Hysong, S. J., Best, R. G., Pugh, J. A., & Moore, F. I. (2005). Not of one mind: Mental models of clinical practice guidelines in the Veteran’s Health Administration. Health Services Research, 40(3), 829–847.

    Article  PubMed  Google Scholar 

  • Jones, A. (2002). Assertive community treatment: Development of the team, selection of clients, and impact on length of hospital stay. Journal of Psychiatric and Mental Health Nursing, 9, 261–270.

    Article  PubMed  CAS  Google Scholar 

  • Koerner, K., & Linehan, M. (2000). Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 23, 151–167.

    Article  PubMed  CAS  Google Scholar 

  • Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.

    Article  Google Scholar 

  • Lang, M. A., Davidson, L., Bailey, P., & Levine, M. S. (1999). Clinicians’ and clients’ perspectives on the impact of assertive community treatment. Psychiatric Services, 50, 1331–1340.

    PubMed  CAS  Google Scholar 

  • Leiter, M. D. (1991). Coping patterns as predictors of burnout: The function of control and escapist coping patterns. Journal of Organizational Behavior, 12, 123–144.

    Article  Google Scholar 

  • Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. Lancet, 364, 453–461.

    Article  PubMed  Google Scholar 

  • Linehan, M. M. (1993a). Cognitive behavior treatment for borderline personality disorder. New York: Guilford.

    Google Scholar 

  • Linehan, M. M. (1993b). Cognitive-behavioral treatment of borderline personality. New York: Guilford Press.

    Google Scholar 

  • Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive behavior treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.

    Article  PubMed  CAS  Google Scholar 

  • Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug dependence. American Journal on Addictions, 8, 279–292.

    Article  PubMed  CAS  Google Scholar 

  • Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.

    Article  PubMed  Google Scholar 

  • Links, P. (1998). Developing effective services for patients with personality disorders. Canadian Journal of Psychiatry, 43, 251–259.

    CAS  Google Scholar 

  • McGlashan, T. H. (1986). The Chestnut Lodge follow-up study: III. Long-term outcome of borderline personalities. Archives of General Psychiatry, 43(1), 20–30.

    Article  PubMed  CAS  Google Scholar 

  • McQuillan, A., Nicastro, R., Guenot, F., Girard, M., Lissner, C., & Ferrero, F. (2005). Intensive dialectical behavioral therapy for outpatients with borderline personality disorder who are in crisis. Psychiatric Services, 56, 193–197.

    Article  PubMed  Google Scholar 

  • Paris, J. (2002). Chronic suicidality in borderline personality disorder. Psychiatric Services, 53, 482–487.

    Article  Google Scholar 

  • Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted from suicidal adolescents. Suicide and Life Threatening Behaviors, 32, 146–157.

    Article  Google Scholar 

  • Reynolds, S., Wolbert, R., Abney-Cunningham, G., & Patterson, K. (2007). Dialectical behaviroal therapy in assertive community treatment teams. In L. Dimeff & K. Koerner (Eds.), Dialectical behavior therapy in clinical practice (pp. 298–323). New York: The Guilford Publications.

    Google Scholar 

  • Rosen, A., & Teeson, M. (2001). Does case management work? The evidence and the abuse of evidence-based medicine. Australian and New Zealand Journal of Psychiatry, 35(6), 731–746.

    Article  PubMed  CAS  Google Scholar 

  • Rosenheck, R. A., & Neale, M. (1998). Intersite variation in the impact of intensive psychiatric community care on hospital use. American Journal of Orthopsychiatry, 68(2), 233–245.

    Article  Google Scholar 

  • Ruberstein, L. V., Mittman, B. S., Yano, E. M., & Mulrow, C. D. (2000). From understanding health care provider behavior to improving health care: The QUERI frameworks for quality improvement. Medical Care, 38(6 Suppl I), I-129–I-141.

    Google Scholar 

  • Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158, 632–634.

    Article  PubMed  CAS  Google Scholar 

  • Stein, L. I., & Santos, A. B. (1998). Assertive community treatment of persons with severe mental illness. New York: Norton.

    Google Scholar 

  • Stein, L. I., & Test, M. A. (1980). An alternative to mental health treatment I: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 142, 392–397.

    Article  Google Scholar 

  • Stone, M. H. (1993). Long-term outcome in personality disorders. British Journal of Psychiatry, 162, 299–313.

    Article  PubMed  CAS  Google Scholar 

  • Swenson, C., Torrey, W., & Koermer, K. (2002). Implementing dialectical behavior therapy. Psychiatric Services, 53, 171–178.

    Article  PubMed  Google Scholar 

  • Swigar, M. E., Astrachan, B., Levine, M. A., Mayfield, V., et al. (1991). Single and repeated admissions to a mental health center: Demographic, clinical and use of service characteristics. International Journal of Social Psychiatry, 37(4), 259–266.

    Article  PubMed  CAS  Google Scholar 

  • Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68, 216–232.

    Article  Google Scholar 

  • Test, M. A. (1992). Training in community living. In R. P. Liberman (Ed.), Handbook of psychiatric rehabilitation (pp. 153–170). New York: MacMillan.

    Google Scholar 

  • Turner, R. M. (2000). Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7, 413–419.

    Article  Google Scholar 

  • Walrath, C. M., Nickerson, K. J., Crowel, R., & Leaf, P. J. (1998). Serving children with serious emotional disturbance in a system of care: Do mental health and non-mental health agency referrals like the same? Journal of Emotional & Behavioral Disorders, 6(4), 205–213.

    Article  Google Scholar 

  • Weisbrod, B. A. (1983). A guide to benefit-cost analysis, as seen through a controlled experiment in treating the mentally ill. Journal of Health & Politics Policy Law, 7, 808–846.

    Article  CAS  Google Scholar 

  • Widiger, T. A., & Frances, A. (1985). Axis II personality disorders: Diagnostic and treatment issues. Hospital & Community Psychiatry, 36(6), 619–627.

    CAS  Google Scholar 

  • Ziguras, S. J., & Stuart, G. W. (2000). Meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatric Services, 51, 1410–1421.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tracee Burroughs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burroughs, T., Somerville, J. Utilization of Evidenced Based Dialectical Behavioral Therapy in Assertive Community Treatment: Examining Feasibility and Challenges. Community Ment Health J 49, 25–32 (2013). https://doi.org/10.1007/s10597-012-9485-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-012-9485-2

Keywords

Navigation