Many individuals with mental health problems do not receive evidence based treatments (EBTs) fitting their clinical profile, despite the many treatments resulting from clinical research during the past few decades. This project proposes to start a line of research that would address two important obstacles to achieving this goal. The first is the current symptom based classification system for mental disorders that guides treatment research towards a single disorder model. The consequences are the many single-disorder treatments existent in the field which: 1) pose difficulty for practitioners to get traine in and maintain adherence, 2) depart from cognitive neuroscience findings identifying mechanisms for dysfunction that go across diagnoses, and 3) do not fit the high comorbidity encountered in clinical practice. The second obstacle is the dearth of cost-effective dissemination mechanisms for EBTs due to high costs of face-to-face treatment, mental health stigma, treatment inaccessibility due to geographical locations, insufficient numbers of trained practitioners, etc. More precisely, I propose to start a line of research that will translate active components of face to-face EBTs (such as Dialectical Behavior Therapy (DBT)) into effective transdiagnostic interventions disseminable on a large scale through technology. The current project seeks to establish a proof of concept within this long- term research direction. Affect dysregulation has emerged from behavioral science and cognitive neuroscience research as a potential transdiagnostic disease process. DBT is a cognitive behavioral treatment with high potential to treat emotion dysregulation trans-diagnoses. DBT skills training has been studied across multiple Axis I disorders and the emotion regulation module in particular has been found effective in increasing emotion regulation. Computerized psychotherapy treatments, taking advantage of many technological advances in portability, interaction are promising in efficacy and hold high potential for treatment dissemination. I propose to develop a computerized version of DBT skills for trans-diagnostic emotion dysregulation (cDBT-ER) based on the DBT skills emotion regulation module. The study will be comprised of two phases: 1) Phase 1 for intervention development, formative evaluation, and integration of feedback, and 2) Phase 2 is for intervention evaluation in individuals with significant difficulties in emotion regulation and meeting diagnostic criteria for at least one mood or anxiety disorder via an open clinical trial of cDBT-ER (pre-post design), and via a comparison with a historical control condition. I hypothesize that cDBT-ER will be effective in improving indices of emotion dysregulation, dysfunctional emotions, skills use and general distress at post-treatment and at 2 months follow-up compared to the pre-treatment assessments. Comparisons with the historical controls will be performed to evaluate the promise of the treatment. These results will inform the design of a subsequent full- scale RCT of the cDBT-ER.

Public Health Relevance

Clinical psychology research has generated many effective treatments targeting many mental disorders. Yet many individuals with mental health problems do not have access to evidence based treatment fitting their clinical profile. This project addresses two barriers to solving this problem: 1) treatment research following the current single-disorder, symptom based classification for mental disorders, and 2) insufficient cost-effective treatment dissemination mechanisms. We propose to develop and evaluate through an open clinical trial a transdiagnostic treatment targeting emotion dysregulation as a common mechanism of disorder. The treatment will be comprised of Dialectical Behavior Therapy skills training in a computerized format that will permit dissemination on a large scale.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZMH1-ERB-K (01))
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Hill, Lauren D
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University of Washington
Schools of Arts and Sciences
United States
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