Category: Gay / Lesbian / Bisexual / Transgender Issues

Symposium

Affirmative DBT Skills Training for Transdiagnostic Emotion Dysregulation and Minority Stress

Sunday, November 19
8:30 AM - 10:00 AM
Location: Sapphire Ballroom K & L, Level 4, Sapphire Level

Keywords: DBT (Dialectical Behavior Therapy) | L / G / B / T | Emotion Regulation
Presentation Type: Symposium

Background/Objective:  Minority stress theory posits that unique stressors create an invalidating environment placing sexual minority individuals at increased risk for psychiatric morbidity (Meyer, 2003). Recent research highlights the association of minority stressors with elevated levels of depression, PTSD, and suicidality among LGB veterans (Cochran, Balsam, Flentje, Malte, & Simpson, 2013). Clinical interventions designed to address the pathways of minority stress and emotional disorders among LGB veterans are warranted. Dialectical Behavior Therapy (DBT) is a treatment that addresses an invalidating environment and emerging evidence suggests that DBT skills training may be efficacious as a stand-alone treatment  for emotion dysregulation, anxiety, and depression (Neacsiu, Eberele, Kramer, Wiesman, & Linehan, 2014; Valentine, Bankoff, Poulin, Rediler, & Pantalone 2014). Little work has investigated how to effectively adapt DBT for sexual minorities or the particularly vulnerable veteran subset of that population. The current research addresses this gap with an LGB affirmative adaptation of the Emotion Regulation module of DBT skills training in order to treat emotional disorders and the underlying minority stress processes. We created a new hand out to teach minority stress as part of the invalidating environment and developed new teaching points to target the pathways of minority stress within the context of existing DBT skills.


Method: Participants (n=4) were sexual minority veterans who reported a clinical level of either depression symptoms or anxiety symptoms.  Two participants identified as female and two participants identified as male.  Participants completed an LGB-affirmative adaptation of the Emotion Regulation module of DBT Skills Training meeting on a weekly basis for 10 consecutive weeks.  Participants completed the PHQ-9, OASIS, and DERS as well as assessments of the minority stress processes of internalized stigma, concealment, and rejection sensitivity, both at baseline and after completion of the group. 


Results: Overall, Affirmative skills training was well received in this sample, with change on each outcome measure in the expected direction.  A paired samples t test revealed a statistically significant decrease in emotion dysregulation on the DERS (t= 3.54, p = .024, ∆=19.6).  Participants also displayed reductions in depression symptoms measured with the PhQ-9 ( ∆=8.25 ) and reductions in anxiety symptoms measured with the OASIS ( ∆=3.75).  Similarly, participants’ mean change scores also revealed reductions in all measures of minority stress.


Conclusion: These findings demonstrate preliminary efficacy of  Affirmative DBT skills training adapted for sexual minority veterans.  We infused new teaching points to target minority stress processes and found reductions in emotional dysregulation, anxiety, depression, and minority stress.  LGB Affirmative DBT ST is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.

Jeffrey Cohen

VA Long Beach Healthcare System

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