IMPULSIVITY AND VIOLENT BEHAVIOR: THE EMPLOYMENT OF DIALECTICAL BEHAVIOR THERAPY IN A FORENSIC SETTING

Abstract

Background: Recent studies have shown that forensic psychiatric patients are among the most aggressive across the entire psychiatric population:
these observations have proved their consistency in North America, Europe and Australia (1) with a percentage of 45.6% of patients committing aggressive
acts in high security forensic units compared to 21.3% of patients committing aggressive acts in generic mental health facilities (2). Despite DBT starts
as an appropriate treatment in reducing impulsive behavior (suicide and self-injuries, rage, aggressiveness, depression) in patients with borderline
personality disorder (NICE, 2009), lately DBT has been empirically supported both in reducing maladaptive behaviors and in enhancing adaptive behavior
in hard to treat forensic psychiatric population. We present a study carried out in the Rems Castore of Subiaco (DSMDP ASL RM5) that
engaged a total of 30 psychiatric offenders undergoing detention. Objective: to detect if the forensic adaptation of standard DBT model by M.M.
Linehan proves to be more effective on impulsivity and alexithymia then treatment as usual. Sample: 30 psychiatric offenders undergoing detention
in REMS Castore are divided into a DBT experimental group (n=15) and a control group (n=15). The samples differ for clinical features (psychosis,
bipolar disorder, personality disorder) and offences. Procedures: the experimental group undergoes individual DBT psychotherapy and DBT skills
group, while the control group is treated as usual (supportive psychotherapy and nonspecific skills group). The attendance is weekly and the sample undergoes a full 12 months treatment. Impulsivity and alexithymia assessment is performed at baseline (T0) and after 12 months (T1) of DBT treatment
application. Data analysis: statistical analysis is performed with SPSS software (21), ANOVA repetitive factor and between groups factors. Results: it
results an interaction effect between the alexithymia scores registered on TAS-20 and the DBT experimental group. This treatment is more effective in
improving alexithymia in the experimental group than in the control group (an interaction effect resulted between the alexithymia scores registered on
TAS-20 and the DBT experimental group). As for impulsivity, all patients improve independently of the group they were assigned to (no interaction
effect resulted).