TY - JOUR
T1 - Processes of Change in a Randomized Clinical Trial of Radically Open Dialectical Behavior Therapy (RO DBT) for Adults With Treatment-Refractory Depression
AU - Gilbert, Kirsten
AU - Codd, R. Trent
AU - Hoyniak, Caroline
AU - Tillman, Rebecca
AU - Baudinet, Julian
AU - Pires, Pedro P.
AU - Hempel, Roelie
AU - Russell, Ian
AU - Lynch, Thomas R.
N1 - Publisher Copyright:
© 2023 American Psychological Association
PY - 2023
Y1 - 2023
N2 - Objective: Radically open dialectical behavior therapy (RO DBT) is an empirically supported psychotherapy for treatment-refractory depression (TRD) that targets psychological inflexibility and interpersonal functioning within the context of maladaptive overcontrol. However, it is unknown whether change in these mechanistic processes is associated with decreased symptoms. This study tested whether change in psychological inflexibility and interpersonal functioning is associated with change in depressive symptoms in RO DBT. Method: Adults with TRD from The Refractory Depression: Mechanisms and Efficacy of RO DBT (RefraMED) randomized controlled trial of RO DBT, n = 250; M (SD) age = 47.2 (11.5); 65% female; 90% White, were assigned to RO DBT or treatment as usual. Psychological inflexibility and interpersonal functioning were assessed at baseline, 3 (midtreatment), 7 (posttreatment), 12, and 18 months. Mediation analyses and latent growth curve modeling (LGCM) assessed whether change in psychological inflexibility and interpersonal functioning was associated with change in depressive symptoms. Results: The effect of RO DBT in decreasing depressive symptoms was mediated by changes in psychological inflexibility and interpersonal functioning at 3 (95% CI [−2.35, −0.15]; [−1.29, −0.04], respectively), 7 (95% CI [−2.80, −0.41]; [−3.39, −0.02]), and only psychological inflexibility at 18 (95% CI [−3.22, −0.62]) months. LGCM indicated only in RO DBT was a decrease in psychological inflexibility through 18 months associated with a decrease in depressive symptoms (B = 0.13, p <.001). Conclusions: This supports RO DBT theory about targeting processes related to maladaptive overcontrol.
AB - Objective: Radically open dialectical behavior therapy (RO DBT) is an empirically supported psychotherapy for treatment-refractory depression (TRD) that targets psychological inflexibility and interpersonal functioning within the context of maladaptive overcontrol. However, it is unknown whether change in these mechanistic processes is associated with decreased symptoms. This study tested whether change in psychological inflexibility and interpersonal functioning is associated with change in depressive symptoms in RO DBT. Method: Adults with TRD from The Refractory Depression: Mechanisms and Efficacy of RO DBT (RefraMED) randomized controlled trial of RO DBT, n = 250; M (SD) age = 47.2 (11.5); 65% female; 90% White, were assigned to RO DBT or treatment as usual. Psychological inflexibility and interpersonal functioning were assessed at baseline, 3 (midtreatment), 7 (posttreatment), 12, and 18 months. Mediation analyses and latent growth curve modeling (LGCM) assessed whether change in psychological inflexibility and interpersonal functioning was associated with change in depressive symptoms. Results: The effect of RO DBT in decreasing depressive symptoms was mediated by changes in psychological inflexibility and interpersonal functioning at 3 (95% CI [−2.35, −0.15]; [−1.29, −0.04], respectively), 7 (95% CI [−2.80, −0.41]; [−3.39, −0.02]), and only psychological inflexibility at 18 (95% CI [−3.22, −0.62]) months. LGCM indicated only in RO DBT was a decrease in psychological inflexibility through 18 months associated with a decrease in depressive symptoms (B = 0.13, p <.001). Conclusions: This supports RO DBT theory about targeting processes related to maladaptive overcontrol.
KW - depression
KW - inflexibility
KW - interpersonal
KW - overcontrol
KW - radically open dialectical behavior therapy
UR - http://www.scopus.com/inward/record.url?scp=85150148754&partnerID=8YFLogxK
U2 - 10.1037/ccp0000795
DO - 10.1037/ccp0000795
M3 - Article
C2 - 36913282
AN - SCOPUS:85150148754
SN - 0022-006X
VL - 91
SP - 71
EP - 81
JO - Journal of Consulting and Clinical Psychology
JF - Journal of Consulting and Clinical Psychology
IS - 2
ER -