L’implementazione della Terapia Dialettico Comportamentale (DBT) nei Servizi di Salute Mentale in Italia

Titolo Rivista PSICOBIETTIVO
Autori/Curatori Michele Sanza, Jeannette Campa, Lavinia Barone
Anno di pubblicazione 2023 Fascicolo 2023/2
Lingua Italiano Numero pagine 15 P. 42-56 Dimensione file 652 KB
DOI 10.3280/PSOB2023-002004
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Qui sotto puoi vedere in anteprima la prima pagina di questo articolo.

Se questo articolo ti interessa, lo puoi acquistare (e scaricare in formato pdf) seguendo le facili indicazioni per acquistare il download credit. Acquista Download Credits per scaricare questo Articolo in formato PDF

Anteprima articolo

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

L’incremento dell’accesso delle persone con Disturbo Borderline di Personalità ai Servizi di Salute Mentale pubblici costituisce una importante sfida per l’aggiornamento delle pratiche professionali attraverso l’implementazione di modelli clinici derivati dalle terapie con evidenze di effi- cacia. In particolare, l’applicazione della Terapia Dialettico Comportamentale nel contesto dei Servizi di Salute Mentale costituisce un esempio di innovazione con importanti risvolti positivi sull’efficacia dei trattamenti e potenzialmente la riduzione dei costi sociali connessi all’epidemiologia dei disturbi di personali- tà. Il progetto della Regione Emilia-Romagna, derivato dalle linee di indirizzo del 2013 sul trattamento dei disturbi gravi di personalità, prevede l’introduzio- ne dello Skill Training della Terapia Dialettico Comportamentale (DBT), da solo o in associazione al case management e al trattamento psichiatrico esperto, come modalità ordinaria dell’approccio al trattamento del Disturbo Borderline di Personalità. Il modello si inserisce in una Stepped care di interventi differen- ziati per livelli di gravità clinica e per gradi di intensità del trattamento nella cornice di valori di riferimento prioritari quali: servizi non giudicanti, empo- werment dei pazienti e degli operatori, priorità degli interventi di carattere psi cosociale nei confronti di quelli farmacologici.;

Keywords:Disturbo Borderline di Personalità; Terapia Dialettico Comportamentale; Implementazione; Stepped care.

  1. Álvarez-Tomás I., Ruiz J., Guilera G., Bados A. (2019). Long-term clinical and functional course of borderline personality disorder: A meta-analysis of pro- spective studies. European psychiatry: the journal of the Association of European Psychiatrists, 56: 75-83.
  2. Behavioral Tech (2021). behavioraltech.org/.
  3. Burroughs T., Somerville J. (2013). Utilization of evidenced based dialectical beha- vioral therapy in assertive community treatment: examining feasibility and chal- lenges. Community mental health journal, 49(1): 25-32.
  4. Chanen A., Sharp C., Hoffman P., Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (2017). Prevention and early intervention for borderline personality disorder: a novel public health priori- ty. World psychiatry: official journal of the World Psychiatric Association (WPA), 16(2): 215-216.
  5. Choi-Kain L.W., Albert E.B., Gunderson J.G. (2016). Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped care. Harvard review of psychiatry, 24(5): 342-356. DOI: 10.1097/HRP.0000000000000113
  6. Cristea I.A., Gentili C., Cotet C.D., Palomba D., Barbui C., Cuijpers P. (2017). Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA psychiatry, 74(4): 319-328.
  7. Delaquis C.P., Joyce K.M., Zalewski M., Katz L.Y., Sulymka J., Agostinho T., Roos L.E. (2022). Dialectical behaviour therapy Skills Training groups for com- mon mental health disorders: A systematic review and meta-analysis. Journal of affective disorders, 300: 305-313.
  8. Flynn D., Joyce M., Spillane A., Wrigley C., Corcoran P., Hayes A., Flynn M., Wyse D., Corkery B., Mooney B. (2019). Does an adapted Dialectical Behaviour Therapy Skills Training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study. Addiction science & clinical practi- ce, 14(1): 28.
  9. Flynn D., Kells M., Joyce M. (2021). Dialectical behaviour therapy: Implementation of an evidence-based intervention for borderline personality disorder in public health systems. Current opinion in psychology, 37: 152-157.
  10. Goodman M., Tomas I.A., Temes C.M., Fitzmaurice G.M., Aguirre B.A., Zanarini M.C. (2017). Suicide attempts and self-injurious behaviours in ado- lescent and adult patients with borderline personality disorder. Personality and mental health, 11(3): 157-163.
  11. Gunderson J.G. (2009). Borderline personality disorder: ontogeny of a diagno- sis. The American journal of psychiatry, 166(5): 530-539.
  12. Heerebrand S.L., Bray J., Ulbrich C., Roberts R.M., Edwards S. (2021). Effectiveness of dialectical behavior therapy Skills Training group for adults with borderline personality disorder. Journal of clinical psychology, 77(7): 1573-1590.
  13. Hermens M.L., van Splunteren P.T., van den Bosch A., Verheul R. (2011). Barriers to implementing the clinical guideline on borderline personality disor- der in the Netherlands. Psychiatric services, 62(11): 1381-1383.
  14. Herschell A.D., Lindhiem O.J., Kogan J.N., Celedonia K.L., Stein, B.D. (2014). Evaluation of an implementation initiative for embedding Dialectical Behavior Therapy in community settings. Evaluation and program planning, 43: 55-63.
  15. Huxley E., Lewis K.L., Coates A.D., Borg W.M., Miller C.E., Townsend M.L., Grenyer B.F.S. (2019). Evaluation of a brief intervention within a stepped care whole of service model for personality disorder. BMC Psychiatry, 19(1), Article 341.
  16. Kells M., Joyce M., Flynn D., Spillane A., Hayes A. (2020). Dialectical behaviour therapy skills reconsidered: applying Skills Training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours. Borderline personality disorder and emotion dysregulation, 7: 3.
  17. King J.C., Hibbs R., Saville C., Swales M.A. (2018). The survivability of dialec- tical behaviour therapy programmes: a mixed methods analysis of barriers and facilitators to implementation within UK healthcare settings. BMC psychiatry, 18(1): 302.
  18. Kramer U., Kolly S., Charbon P., Ilagan G.S., Choi-Kain L.W. (2022). Brief psychiatric treatment for borderline personality disorder as a first step of care: Adapting general psychiatric management to a 10-session intervention. Personality disorders, 13(5): 516-526.
  19. Laporte L., Paris J., Bergevin T., Fraser R., Cardin J.F. (2018). Clinical outcomes of a stepped care program for borderline personality disorder. Personality and mental health, 12(3): 252-264.
  20. Linehan M.M. (1993). Cognitive-behavioral treatment of borderline personality disor- der. New York: The Guilford Press.
  21. Linehan M.M., Heard H.L. (1999). Borderline personality disorder: Costs, course, and treatment outcomes. In: Miller N.E., Magruder K.M. (eds.). Cost-effectiveness of psychotherapy: A guide for practitioners, researchers, and policymakers (pp. 291- 305). Oxford: Oxford University Press.
  22. Linehan M.M., Korslund K.E., Harned M.S., Gallop R.J., Lungu A., Neacsiu A.D., McDavid J., Comtois K.A., Murray-Gregory A.M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA psychiatry, 72(5): 475-482.
  23. McMain S.F., Guimond T., Barnhart R., Habinski L., Streiner D.L. (2017). A randomized trial of brief dialectical behaviour therapy Skills Training in suici- dal patients suffering from borderline disorder. Acta psychiatrica Scandinavica, 135(2): 138-148.
  24. McMain S.F., Links P.S., Gnam W.H., Guimond T., Cardish R.J., Korman L., Streiner D.L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. The American journal of psychiatry, 166(12): 1365-1374.
  25. Millon T. (2010). A sociocultural conception of the borderline personality disorder epidemic. In: Millon T., Krueger R.F., Simonsen E. (eds.). Contemporary direc- tions in psychopathology: Scientific foundations of the DSM-V and ICD-11 (pp. 111-123). New York: The Guilford Press.
  26. Murphy A., Bourke J., Flynn D., Kells M., Joyce M. (2020). A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community. Irish journal of medical science, 189(2): 415-423.
  27. National Collaborating Centre for Mental Health (UK) (2009). Borderline Personality Disorder: Treatment and Management. British Psychological Society.
  28. National Health and Medical Research Council, Australian Research Council (2012)
  29. Neacsiu A.D., Eberle J.W., Kramer R., Wiesmann T., Linehan M.M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial. Behaviour research and therapy, 59: 40-51.
  30. Olesen J., Gustavsson A., Svensson M., Wittchen H.U., Jönsson B., CDBE2010 study group, European Brain Council (2012). The economic cost of brain disorders in Europe. European journal of neurology, 19(1): 155-162.
  31. Paolini E., Mezzetti F.A., Pierri F., Moretti P. (2017). Pharmacological treatment of borderline personality disorder: a retrospective observational study at inpatient unit in Italy. International journal of psychiatry in clinical practice, 21(1): 75-79. DOI: 10.1080/13651501.2016.1235202
  32. Paris J. (2013). Stepped care: an alternative to routine extended treatment for pa- tients with borderline personality disorder. Psychiatric services, 64(10): 1035- 1037.
  33. Pompili M., Girardi P., Ruberto A., Tatarelli R. (2005). Suicide in borderline per- sonality disorder: a meta-analysis. Nordic journal of psychiatry, 59(5): 319-324. DOI: 10.1080/08039480500320025
  34. SISM (2020). Rapporto salute mentale. SISM. www.salute.gov.it/portale/documen- tazione/p6_2_2_1.jsp?lingua=italiano&id=3212.
  35. Servizio Salute Mentale, Dipendenze Patologiche e Salute nelle Carceri Regione Emilia-Romagna (2013). Linee di indirizzo per il trattamento dei disturbi gravi di personalità. Bologna.
  36. SIDBT (2022). A cosa serve la DBT. -- www.sidbt.it/dbt/a-cosa-serve-la-dbt/.
  37. Soeteman D.I., Busschbach J.J., Verheul R., Hoomans T., Kim, J.J. (2011). Cost- effective psychotherapy for personality disorders in the Netherlands: the value of further research and active implementation. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research, 14(2): 229-239.
  38. Soler J., Pascual J.C., Tiana T., Cebrià A., Barrachina J., Campins M.J., Gich I., Alvarez E., Pérez V. (2009). Dialectical behaviour therapy Skills Training com- pared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour research and therapy, 47(5): 353-358.
  39. Storebø O.J., Stoffers-Winterling J.M., Völlm B.A., Kongerslev M.T., Mattivi J.T., Jørgensen M.S., Faltinsen E., Todorovac A., Sales C.P., Callesen H.E., Lieb K., Simonsen E. (2020). Psychological therapies for people with bor- derline personality disorder. The Cochrane database of systematic reviews, 5(5): CD012955.
  40. Swales M. (2010a). Implementing DBT: Organisational pre-treatment. Cognitive Behaviour Therapist, 3: 145-157.
  41. Swales M.A., Taylor B., Hibbs R.A. (2012). Implementing Dialectical Behaviour Therapy: programme survival in routine healthcare settings. Journal of mental health, 21(6): 548-555. DOI: 10.3109/09638237.2012.689435
  42. Toms G., Williams L., Rycroft-Malone J., Swales M., Feigenbaum J. (2019). The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review. Borderline personality disorder and emotion dysregulation, 6: 2.
  43. Valentine S.E., Smith A.M., Stewart K. (2020). A review of the empirical eviden- ce for Skills Training DBT as a stand-alone intervention. In: Bedics J. (ed.). The handbook of dialectical behavior therapy: Theory, research, and evaluation (pp. 325- 358). Cambridge: Elsevier Academic Press. DOI: 10.1016/B978-0-12-816384-9.00015-4
  44. Vicari S., Pontillo M. (2022). Gli adolescenti e la pandemia. Salute mentale al tempo del Covid-19. Milano: Edizioni LSWR.
  45. Zanarini M.C. (2009). Psychotherapyofborderlinepersonalitydisorder. Actapsychia- trica Scandinavica, 120(5): 373-377.

Michele Sanza, Jeannette Campa, Lavinia Barone, L’implementazione della Terapia Dialettico Comportamentale (DBT) nei Servizi di Salute Mentale in Italia in "PSICOBIETTIVO" 2/2023, pp 42-56, DOI: 10.3280/PSOB2023-002004