Special Series Dialectical Behavior Therapy: Adaptations And New Applications
Treatment of elderly depression with personality disorder comorbidity using dialectical behavior therapy*

https://doi.org/10.1016/S1077-7229(00)80058-9Get rights and content

Depression among older adults is a particularly distressing problem, not only because of high rates but also because of higher risks for suicide among this population. In addition, personality disordered depressed elderly have been shown to be less responsive to depression-specific therapies. This article reviews the rationale and treatment modifications under development for treatment of elderly depressed patients with comorbid personality disorders using Dialectical Behavior Therapy.

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      Research suggests that DBT can be conducted with various adult populations, including outpatient,7–11 inpatient,6,12,14–17 and forensic.18–20 Research has also expanded and diversified to included adaptations of DBT for adults with comorbid BPD and substance abuse problems,10,16,21 comorbid BPD and eating disorders,22 eating disorders,23,24 and geriatric outpatients with depression and mixed personality features.13,25 For a comprehensive review of clinical outcome studies, see Lynch, Trost, Salsman, and Linehan.5

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      Based on the dialectical perspective of DBT, the therapy teaches clients to achieve balance on several “poles” of cognitive, affective, and behavioral functioning (“dialectical dilemmas”), such that rigid or extreme stances are relaxed in favor of more flexible and adaptive responses. Poles adapted for depression in older adults relate to styles of trying to solve problems, accepting reality, relating to others, and maintaining a sense of self.29 Consequently, for this study, we predicted that DBT would influence personality and coping styles that may increase vulnerability to future depressive episodes (e.g., interpersonal reactivity36 and/or emotional ambivalence37)

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    *

    This work was supported by National Institute of Mental Health Grants R03 MH057799 and P30 MH401159-14 and by a grant from the John A. Hartford Foundation.

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