Behavioral Research and Therapy Clinics — University of Washington — Home



The Behav­ioral Research and Ther­apy Clin­ics (BRTC) is a clin­i­cal research cen­ter focus­ing pri­mar­ily on the devel­op­ment and eval­u­a­tion of psy­chother­a­pies for indi­vid­u­als with severe and chronic per­son­al­ity dis­or­ders.  The research, which has been funded by the National Insti­tute of Health, the Bor­der­line Per­son­al­ity Dis­or­der Research Foun­da­tion, the Ben­nett Fam­ily Foun­da­tion and oth­ers, focuses on the under­stand­ing, assess­ment, and treat­ment of sui­ci­dal behav­iors, drug addic­tion and of Bor­der­line Per­son­al­ity Dis­or­der. The pri­mary treat­ment under devel­op­ment at the BRTC is termed Dialec­ti­cal Behav­ior Ther­apy, which is a cog­ni­tive behav­ioral treat­ment devel­oped by Dr. Mar­sha M. Line­han.  The BRTC is a free-standing unit at the Uni­ver­sity of Wash­ing­ton whose funding-to-date has been through research grants and con­sult­ing income gen­er­ated by research staff.  »Read more 

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NEWRecruit­ing for research study: Com­put­er­ized Dialec­ti­cal Behav­ior Ther­apy Skills Train­ing. Click here for more information.

OPEN: Dialec­ti­cal Behav­ior Ther­apy Friends and Fam­ily Group. Click here for more information.

OPEN: Dialec­ti­cal Behav­ior Ther­apy for ado­les­cents and adults. Click here for more information.

NOW PUBLISHED! Mar­sha Linehan’s Updated Skills Manuals


For Ther­a­pists. Pro­vides vital tools for imple­ment­ing DBT skills train­ing. The teach­ing notes and repro­ducible hand­outs and work­sheets used for over two decades by hun­dreds of thou­sands of prac­ti­tion­ers have been sig­nif­i­cantly revised and expanded to reflect impor­tant research and clin­i­cal advances. Click here for 20% off.





For Clients. Fea­tures more than 225 user-friendly hand­outs and work­sheets, to be used by clients in dialec­ti­cal behav­ior ther­apy (DBT) skills train­ing groups or indi­vid­ual ther­apy. All of the hand­outs and work­sheets dis­cussed in Mar­sha M. Linehan’s DBT Skills Train­ing Man­ual, Sec­ond Edi­tion, are pro­vided, together with brief intro­duc­tions to each mod­ule writ­ten expressly for clients. Click here for 20% off.

Recent Posts

Outside Research on DBT and BPD — April 2015

1.   Clas­si­cal con­di­tion­ing in bor­der­line per­son­al­ity dis­or­der: an fMRI study
A Krause-Utz, J Keibel-Mauchnik, U Ebner-Priemer… — Euro­pean Archives of …, 2015
Pre­vi­ous research sug­gests dis­turbed emo­tional learn­ing and mem­ory in bor­der­line per­son­al­ity dis­or­der (BPD). Stud­ies inves­ti­gat­ing the neural cor­re­lates of aver­sive dif­fer­en­tial delay con­di­tion­ing in BPD are cur­rently lack­ing. We aimed to inves­ti­gate acqui­si­tion, within-session extinc­tion, between-session extinc­tion recall, and reac­qui­si­tion. We expected increased acti­va­tion in the insula, amyg­dala, and ante­rior cin­gu­late, and decreased pre­frontal acti­va­tion in BPD patients. Dur­ing func­tional mag­netic res­o­nance imag­ing, 27 medication-free female BPD patients and 26 female healthy con­trols (HC) per­formed a dif­fer­en­tial delay aver­sive con­di­tion­ing par­a­digm. An elec­tric shock served as uncon­di­tioned stim­u­lus, two neu­tral pic­tures as con­di­tioned stim­uli (CS+/CS−). Depen­dent vari­ables were blood-oxygen-level-dependent response, skin con­duc­tance response (SCR), and sub­jec­tive rat­ings (valence, arousal). No sig­nif­i­cant between-group dif­fer­ences in brain acti­va­tion were found [all p(FDR) > 0.05]. Within-group com­par­isons for CS+unpaired > CS− revealed increased insula activ­ity in BPD patients but not in HC dur­ing early acqui­si­tion; dur­ing late acqui­si­tion, both groups recruited fronto-parietal areas [p(FDR) < 0.05]. Dur­ing extinc­tion, BPD patients rated both CS+ and CS− as sig­nif­i­cantly more arous­ing and aver­sive than HC and acti­vated the amyg­dala in response to CS+. In con­trast, HC showed increased pre­frontal activ­ity in response to CS+ > CS dur­ing extinc­tion. Dur­ing extinc­tion recall, there was a trend for stronger SCR to CS+ > CS in BPD patients. Amyg­dala habit­u­a­tion to CS+paired (CS+ in tem­po­ral con­tin­gency with the aver­sive event) dur­ing acqui­si­tion was found in HC but not in patients. Our find­ings sug­gest altered tem­po­ral response pat­terns in terms of increased vig­i­lance already dur­ing early acqui­si­tion and delayed extinc­tion processes in indi­vid­u­als with BPD.

2.   Adult attach­ment and emo­tion dys­reg­u­la­tion in bor­der­line per­son­al­ity and somato­form dis­or­ders
A van Dijke, JD Ford — Bor­der­line Per­son­al­ity Dis­or­der and Emo­tion …, 2015
Back­ground: Bor­der­line per­son­al­ity dis­or­der (BPD) and somato­form dis­or­ders (SoD) involve sig­nif­i­cant prob­lems in rela­tion­ships and emo­tion reg­u­la­tion, but the sim­i­lar­i­ties and dif­fer­ences between these dis­or­ders in these areas is not well under­stood.
Method: In 472 psy­chother­apy inpa­tients BPD and/or SoD diag­noses were con­firmed or ruled out using clin­i­cal inter­views and stan­dard­ized mea­sures. Emo­tional under– and over-regulation and indices of adult attach­ment work­ing mod­els and fears were assessed with val­i­dated self-report mea­sures. Bivari­ate and mul­ti­vari­ate analy­ses were con­ducted to exam­ine rela­tion­ships among the study vari­ables and dif­fer­ences based on diag­nos­tic sta­tus.
Results: Under-regulation of emo­tion was mod­er­ately related to fear of aban­don­ment but weakly related to fear of close­ness. Over-regulation of emo­tion was mod­er­ately related to fear of close­ness but not to fear of aban­don­ment. BPD was asso­ci­ated with under-regulation of emo­tion and fear of aban­don­ment, and, when comor­bid with SoD, with fear of close­ness. SoD was asso­ci­ated with inhi­bi­tion or denial of fears of aban­don­ment or close­ness, and over-regulation of emo­tion.
Con­clu­sions: Study results sug­gest that inse­cure attach­ment may play a role in both BPD and SoD, but in dif­fer­ent ways, with hyper­ac­ti­vat­ing emo­tion dys­reg­u­la­tion promi­nent in BPD and deac­ti­vat­ing emo­tion dys­reg­u­la­tion evi­dent in SoD. Also, com­bined hyper– and de-activating strat­egy com­po­nents that may reflect a pat­tern of dis­or­ga­nized attach­ment were found, par­tic­u­larly in patients with comor­bid BPD and SoD.

3.   Rejec­tion sen­si­tiv­ity and symp­tom sever­ity in patients with bor­der­line per­son­al­ity dis­or­der: effects of child­hood mal­treat­ment and self-esteem
M Bungert, L Liebke, J Thome, K Haeus­sler, M Bohus…Personality Dis­or­der and..,2015
Back­ground: Inter­per­sonal dys­func­tion in Bor­der­line Per­son­al­ity Dis­or­der (BPD) is char­ac­ter­ized by an ‘anx­ious pre­oc­cu­pa­tion with real or imag­ined aban­don­ment’ (DSM-5). This symp­tom descrip­tion bears a close resem­blance to that of rejec­tion sen­si­tiv­ity, a cog­ni­tive affec­tive dis­po­si­tion that affects per­cep­tions, emo­tions and behav­ior in the con­text of social rejec­tion. The present study inves­ti­gates the level of rejec­tion sen­si­tiv­ity in acute and remit­ted BPD patients and its rela­tion to BPD symp­tom sever­ity, child­hood mal­treat­ment, and self-esteem.
Meth­ods: Data were obtained from 167 female sub­jects: 77 with acute BPD, 15 with remit­ted BPD, and 75 healthy con­trols who were matched with the patients for age and edu­ca­tion. The instru­ments used for assess­ment were the Rejec­tion Sen­si­tiv­ity Ques­tion­naire, the short ver­sion of the Bor­der­line Symp­tom List, the Child­hood Trauma Ques­tion­naire, and the Rosen­berg Self-Esteem Scale.
Results: Both acute and remit­ted BPD patients had higher scores on the Rejec­tion Sen­si­tiv­ity Ques­tion­naire than did healthy con­trols. Lower self-esteem was found to be pos­i­tively cor­re­lated with both increased BPD symp­tom sever­ity and higher rejec­tion sen­si­tiv­ity, and medi­ated the rela­tion between the two. His­tory of child­hood mal­treat­ment did not cor­re­late with rejec­tion sen­si­tiv­ity, BPD symp­tom sever­ity, or self-esteem.
Con­clu­sions: Our find­ings sup­port the hypoth­e­sis that rejec­tion sen­si­tiv­ity is an impor­tant com­po­nent in BPD, even for remit­ted BPD patients. Level of self-esteem appears to be a rel­e­vant fac­tor in the rela­tion­ship between rejec­tion sen­si­tiv­ity and BPD symp­tom sever­ity. Ther­a­peu­tic inter­ven­tions for BPD would do well to tar­get rejec­tion sensitivity.

4.   Emo­tional hyper­re­ac­tiv­ity in response to child­hood abuse by pri­mary care­givers in patients with bor­der­line per­son­al­ity dis­or­der
J Lobbestael, A Arntz — Jour­nal of Behav­ior Ther­apy and Exper­i­men­tal …, 2015
Back­ground: One of the core pos­tu­lated fea­tures of bor­der­line per­son­al­ity dis­or­der (BPD) is extreme emo­tional reac­tiv­ity to a wide array of evoca­tive stim­uli. Find­ings from pre­vi­ous exper­i­men­tal research how­ever are mixed, and some the­o­ries sug­gest speci­ficity of hyper emo­tional responses, as being related to abuse, rejec­tion and aban­don­ment only.
Objec­tive: The cur­rent exper­i­ment exam­ines the speci­ficity of emo­tional hyper­re­ac­tiv­ity in BPD.
Method: The impact of four film clips (BPD-specific: child­hood abuse by pri­mary care­givers; BPD-nonspecific: peer bul­ly­ing; pos­i­tive; and neu­tral) on self-reported emo­tional affect was assessed in three female groups; BPD-patients (n = 24), clus­ter C per­son­al­ity dis­or­der patients (n = 17) and non-patient con­trols (n = 23).
Results: Results showed that com­pared to the neu­tral film clip, BPD-patients reacted with more over­all neg­a­tive affect fol­low­ing the child­hood abuse clip, and with more anger fol­low­ing the peer bul­ly­ing clip than the two other groups.
Lim­i­ta­tions: The cur­rent study was restricted to assess­ment of the impact of evoca­tive stim­uli on self-reported emo­tions, and the order in which the film clips were pre­sented to the par­tic­i­pants was fixed.
Con­clu­sions: Results sug­gest that BPD-patients only react gen­er­ally exces­sively emo­tional to stim­uli related to child­hood abuse by pri­mary care­givers, and with exces­sive anger to peer-bullying stim­uli. These find­ings are thus not in line with the core idea of gen­eral emo­tional hyper­re­actvity in BPD.

5.   Impul­siv­ity and Non­sui­ci­dal Self-Injury: A Review and Meta-Analysis
CA Hamza, T Willoughby, T Hef­fer — Clin­i­cal Psy­chol­ogy Review, 2015
Non­sui­ci­dal self-injury (NSSI; direct self-injury with­out lethal intent) often is thought to be asso­ci­ated with impulse con­trol prob­lems. Recent research, how­ever, offers con­flict­ing results about whether impul­siv­ity is a risk fac­tor for NSSI engage­ment. To dis­en­tan­gle find­ings on the link between impul­siv­ity and NSSI, an exten­sive review of the lit­er­a­ture was con­ducted using sev­eral elec­tronic data­bases (i.e., Psych­Info, Psy­chAr­ti­cles, ERIC, CINAHL, and MEDLINE). In total, 27 stud­ies that met the spe­cific inclu­sion cri­te­ria were iden­ti­fied. Results of a meta-analysis revealed that indi­vid­u­als who engaged in NSSI self-reported greater impul­siv­ity than indi­vid­u­als who did not engage in NSSI, and that this effect was most con­sis­tent for mea­sures of neg­a­tive urgency. In con­trast, there was lit­tle evi­dence of an asso­ci­a­tion between lab-based mea­sures of impul­siv­ity (e.g., Go/No-Go, Stop/Signal Task) and NSSI. More­over, the link between impul­siv­ity and NSSI found for self-report mea­sures was some­times elim­i­nated when other risk fac­tors for NSSI were con­trolled (e.g., abuse, depres­sion, post-traumatic stress dis­or­der). In addi­tion to inte­grat­ing find­ings, the present review pro­vides sev­eral expla­na­tions for the dis­crep­an­cies in find­ings between stud­ies employ­ing self-report ver­sus lab-based mea­sures of impul­siv­ity. To con­clude, sev­eral spe­cific rec­om­men­da­tions for future research direc­tions to extend the lit­er­a­ture on impul­siv­ity and NSSI are offered.

  1. Marsha Linehan #1 on Social Work Bestseller List! Comments Off
  2. Effectiveness of Dialectic Behavioral Therapy in routine outpatient care: the Berlin Borderline Study Comments Off
  3. New Research on DBT and BPD Comments Off
  4. Announcing the First Intensive Training in the DBT Prolonged Exposure Protocol Comments Off
  5. Anita Lungu Wins APA Dissertation Research Award Comments Off
  6. Marsha Linehan Interviewed on King5 Healthlink Program Comments Off
  7. Marsha Linehan Featured in espnW Comments Off
  8. DBT Launches in Ireland Comments Off
  9. DBT Featured in Green Bay’s Local Paper Comments Off