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The use of Dialectical Behavior Therapy skills in a clinical sample: Initial findings on the Italian version of the DBT Ways of Coping Checklist

Poster · October 2014

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 The use of Dialectical Behavior Therapy skills in a clinical sample:
initial findings on the Italian version of the DBT Ways of Coping Checklist
1,2 * 2 2 2 1,2
Emanuela Roder , Mauro Cavarra , Nicolò Gaj , Raffaele Visintini & Cesare Maffei
1 2
Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milan, Italy

INTRODUCTION DBT-WCCL predictive validity. Linear regression analyses were performed in order to evaluate the ef-
Borderline Personality Disorder (BPD) is a severe disorder marked by a pervasive pattern of instability ficiency of DBT-WCCL scales in predicting dimensionally assessed DSM-IV PDs and personality di-
in affect, self-image, interpersonal relationships, and goal-directed behavior (American Psychiatric As- mensions relevant to skills training modules: we considered DERS for emotion regulation strategies,
sociation, 2000). Dialectical behavior therapy (DBT; Linehan, 1993) is an evidence-based treatment for MAAS and FFMQ for mindfulness abilities, TCI-R Self-directedness for the capacity of acting with
BPD, founded on the assumption that deficits in self-regulation strategies contribute to the misery of purposefulness in a dialectical way, and TCI-R Cooperativeness for interpersonal effectiveness. The ef-
patients’ life. Therefore, DBT program is about promoting a reality-oriented and dialectic thinking by fects of age, sex, and setting of assessment were kept constant. Predictors to were selected using a step-
teaching and coaching adaptive behavioral skills, grouped into four modules: mindfulness (stay in the wise algorithm. Significant (i.e., p < .05) predictors are listed in Table 2.
present effectively and without judgment), emotion regulation (identification and management of emo-
tional states), distress tolerance (cope with overwhelming emotions and unchangeable events), and in- Table 2. DBT-WCCL subscales predictive validity
terpersonal effectiveness (balance self-respect and relationship importance).
Dysfunctional Dysfunctional
The Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL; Neacsiu et al., 2010) was DBT Skills
Coping Coping R2adj
Use
developed to measure coping strategies from Linehan’s perspective. It was developed adding items Subscale I Subscale II
specific for DBT skills to the Revised Ways of Coping Checklist (RWCCL; Vitaliano et al., 1985) and it BPD traits -.263 ** .216 * .363
was composed by three subscales: the DBT Skills Subscale, assessing DBT skills, the Dysfunctional NPD traits -.226 * .162
Coping Subscale I, a general dysfunctional coping factor, and the Dysfunctional Coping Subscale II,
DERS Nonacceptance -.194 * .396 ^ .206
the tendency to blaming others; the last two subscales were summarized in the Dysfunctional Coping
DERS Goals -.379 ^ .266 ^ .269
Subscale. The psychometric properties of the test were satisfactory in the validation study. DERS Impulse -.425 ^ .333 ^ .403
DERS Awareness -.329 ** .109
DERS Strategies -.369 ^ .407 ^ .363
AIMS OF THE PRESENT STUDY
DERS Clarity -.461 ^ .273 ** .332
• Assess reliability and psychometric properties of the Italian translation of the DBT-WCCL in a clini- DERS Total -.462 ^ .377 ^ .48
cal outpatient sample
MAAS .256 * -.311 ** .147
• Examine the influence of socio-demographic (i.e., age, gender) and clinical (i.e., assessment setting) FFMQ Observe .264 * .11
variables on the DBT Skills Subscale and the Dysfunctional Coping Subscale FFMQ Describe .447 ^ .174
FFMQ Acting with awareness .222 * -.348 ** .127
• Evaluate the predictive validity of DBT-WCCL scales with respect to dimensionally assessed DSM-
FFMQ No react .294 ** .239
IV Personality Disorders and personality dimensions relevant to skills training
TCI-R Self-Directedness .321 ^ -.397 ^ -.201 * .384
TCI-R Cooperativeness .369 ** -.406 ^ .222
METHODS
Note. BPD: DSM-IV Borderline Personality Disorder; NPD: DSM-IV Narcissistic Personality Disor-
Subjects. The DBT-WCCL was administered to 100 adult clinical subjects consecutively admitted to
der. * p < .05; ** p < .005; ^ p < .001
the Clinical Psychology and Psychotherapy Unit of the San Raffaele Turro Hospital in Milan, Italy,
asking for a psychotherapeutic treatment.
The sample included 28 males and 72 females. The mean age was 30.41 years (SD = 12.974). Almost DISCUSSION
all subjects were unmarried (N = 80). About half were unemployed (N = 39); the more frequent profes- Psychometric properties of the Italian version of the DBT-WCCL are satisfactory.
sional status were clerical worker (N = 24) and student (N = 20). 76 subjects were assessed in an ambu- Controlling for age, gender, and assessment setting, the number of BPD traits was predicted both by
latory setting, while 24 subjects were assessed during hospitalization. low DBT skills use and dysfunctional ways of coping characterized by blaming others; a general dys-
27 subjects had at least one Axis I disorder: 3 were diagnosed with mood disorder, 6 with anxiety disor- functional coping was no longer a predictor. Since the regression model explained the 36% of the ob-
der, 5 with eating disorder, and 14 with alcohol/substance abuse disorder. DSM-IV Personality Disor- served variance, DBT could be considered a treatment program tailored for a large amount of BPD
ders were assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, clinical features. The number of NPD traits, instead, was predicted by low general dysfunctional cop-
Version 2.0 (SCID-II; First et al., 1994). 88 subjects were diagnosed with at least one Personality Dis- ing scores – or by low awareness, or partial report, of them; however, since the model accounted only
order: the more frequent ones were Borderline (N = 47) and Narcissistic (N = 14); the other Axis II Per- for 16% of the variance of the dependent variable, DSM-IV Narcissistic Personality Disorder seems to
sonality Disorders did not exceed the 5% of SCID-II diagnosis. have little in common with poor coping strategies, and still less with DBT skills deficits.
Measures. The following assessment instruments were used: DERS subscales were related to low DBT skills use and problematic ways of coping strategies, con-
firming that DBT skills training is an appropriate therapeutic indication for incrementing adaptive
• Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL; Neacsiu et al., 2010)
emotion regulation abilities. The tendency to act without thinking when experiencing negative affec-
• Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) tive states was predicted by the habit to blame others – that is, external locus of control.
• Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006) Despite the hypothesis of the original DBT-WCCL validation study (Neacsiu et al., 2010) that mindful-
• Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003) ness abilities would be not well-represented in the questionnaire, we found demonstrations of predic-
tive validity. The abilities of awareness and attention were predicted both by high mastery in DBT
• Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II; First
skills and low familiarity with ineffective coping strategies. The abilities of describing and not reacting
et al., 1994)
to any personal experience seemed to be specifically related to a good exercise of DBT skills. Interest-
• Temperament and Character Inventory – Revised (TCI-R; Cloninger, 1999) ingly, the ability to observe (that is, just noticing, without judging) was predicted by high general dys-
functional coping, while the capacity of judgment abstinence showed no relationships at all with DBT-
RESULTS WCCL subscales: these results opened questions on the comprehension and the knowledge in our sam-
Reliability and psychometric properties. Cronbach α coefficients was used to assess the internal con- ple of what mindfulness practice really is, despite the meaning of the words in common language, in
sistency of the DBT-WCCL scales: all DBT-WCCL scales showed satisfactory α values (i.e., as > .7), particular with respect to the acceptance of internal and external reality. Overall, we should notice that
mindfulness dimensions were accounted only partially by DBT-WCCL subscales, suggesting that daily
as shown in Table 1. Mean inter-item correlations were acceptable, although the Dysfunctional Coping
Subscale I showed some unsatisfactory (i.e., r < .20) item-total r values. Pearson r coefficients were mindfulness practice goes beyond DBT skills training, since it comprises complex aspects of mental
calculated in order to assess the associations between DBT-WCCL subscales: DBT Skills Use was non functioning.
-significantly associated with the other scales, while all Dysfunctional Coping subscales were strongly TCI-R Self-Directedness and Cooperativeness, which retrieve a more sophisticated expression of DBT
reciprocally associated, even controlling for the effects of age and gender (rspartial > .4, ps < .001). skills practice, were predicted both by frequent DBT skills use and low dysfunctional coping scores,
confirming their ability to describe personality strengths, as proposed in Cloninger’s model (1999).
Influence of socio-demographic and clinical variables. A significant correlation between age and the
Dysfunctional Coping Subscale I was found, r = -.326, p < .005. The Dysfunctional Coping Subscale I Finally, our analyses indicate that age is inversely related to the presence of dysfunctional coping strat-
was higher in females (M = 2.03, SD = .466) than males (M = 1.74, SD = .463), F(1, 96) = 5.183, p egies, thus particular attention is recommended in the treatment of young subjects.
< .05, and also the Dysfunctional Coping Subscale II was higher in females (M = 1.63, SD = .821) than
males (M = 1.16, SD = .589), F(1, 96) = 5.285, p < .05; however, results could be affected by the non-
equal proportion in the sample of male and female subjects. In examining the effect of assessment set- References
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* Please, address correspondence to: roder.emanuela@unisr.it

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