Video Intervention Adjuncts
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 9/7/2018 |
| Start Date: | July 26, 2018 |
| End Date: | July 2019 |
| Contact: | Lorraine T Benuto, M.A. |
| Email: | rorynewlands@gmail.com |
| Phone: | 17757505726 |
Evaluating the Clinical Utility and Client Acceptability of Video Intervention
Intimate partner violence (IPV) is a common occurrence in the U.S. Victims of IPV are at an
elevated risk of experiencing a variety of physical and mental health consequences, which
frequently co-occur and act synergistically, placing victims at a higher risk for
revictimization. Experts recommend that interventions for victims of IPV focus on helping
victims attain more balanced emotions and behaviors, rather than treating specific
nosologies. One transdiagnostic treatment, Dialectical Behavior Therapy (DBT), focused on
helping individuals gain more balanced emotions and behaviors, has shown success in treating
victims of IPV. However, the DBT for IPV treatment protocol is not without it's limitations.
Specifically, clients may need additional exposure to the skills and concepts taught in the
treatment. Yet, additional exposure to the skills facilitated though a therapist is difficult
to do given the limited budgets for services for victims of IPV and the client provider gap.
In order to address the client provider gap, increase exposure to the skills, and to increase
skills acquisition and generalization, video intervention adjuncts (VIAs) have been developed
to serve as treatment adjuncts for the DBT for IPV skills group.
The objective of the current study is to conduct a randomized control trial examining the
treatment utility and participant acceptability of the two-day DBT for IPV skills group plus
the VIAs versus treatment as usual (the two-day DBT for IPV skills group without the VIAs).
The following hypotheses will be examined: 1) those in the experimental VIA condition will
experience treatment gains above and beyond those in the control (treatment as usual)
condition; 2) those in the experimental VIA condition will view the VIAs as acceptable; and
3) those in the experimental VIA condition will report a greater frequency of using the
skills than those in the control condition.
elevated risk of experiencing a variety of physical and mental health consequences, which
frequently co-occur and act synergistically, placing victims at a higher risk for
revictimization. Experts recommend that interventions for victims of IPV focus on helping
victims attain more balanced emotions and behaviors, rather than treating specific
nosologies. One transdiagnostic treatment, Dialectical Behavior Therapy (DBT), focused on
helping individuals gain more balanced emotions and behaviors, has shown success in treating
victims of IPV. However, the DBT for IPV treatment protocol is not without it's limitations.
Specifically, clients may need additional exposure to the skills and concepts taught in the
treatment. Yet, additional exposure to the skills facilitated though a therapist is difficult
to do given the limited budgets for services for victims of IPV and the client provider gap.
In order to address the client provider gap, increase exposure to the skills, and to increase
skills acquisition and generalization, video intervention adjuncts (VIAs) have been developed
to serve as treatment adjuncts for the DBT for IPV skills group.
The objective of the current study is to conduct a randomized control trial examining the
treatment utility and participant acceptability of the two-day DBT for IPV skills group plus
the VIAs versus treatment as usual (the two-day DBT for IPV skills group without the VIAs).
The following hypotheses will be examined: 1) those in the experimental VIA condition will
experience treatment gains above and beyond those in the control (treatment as usual)
condition; 2) those in the experimental VIA condition will view the VIAs as acceptable; and
3) those in the experimental VIA condition will report a greater frequency of using the
skills than those in the control condition.
Dialectical Behavioral Therapy as a treatment for IPV victims. Integrating the literature on
efficacious cognitive behavioral treatments for disorders such as anxiety, depression, and
other emotion regulation difficulties, Linehan developed the framework for DBT.1 In addition
to these traditional CBT change-oriented techniques, which may leave clients feeling blamed
for their problems or situation, Linehan incorporated radical acceptance. Radical acceptance
emphasizes that self-compassion and acceptance (i.e. accepting how things really are rather
than how they 'should' be) are necessary for making meaningful changes. When operating from a
DBT framework the therapist's goal is to balance and synthesize acceptance and
change-oriented strategies. Individuals who have experienced IPV often struggle to accept
their situation (e.g. "But I love him," or "he said he will never do it again… although he
said that before") and often receive blame from others for their situation (e.g. "Why
wouldn't you just leave?"). Treating victims of IPV using a DBT framework allows victims to
learn skills to change their situation in a non-judgmental and validating environment.
In addition to providing victims with a validating environment, DBT aims to foster emotion
regulation, enhance interpersonal effectiveness, improve self-validation, and increase
distress tolerance. Mindfulness (i.e. present-moment awareness, acceptance, and participation
without judgment) is core to these skills and to DBT. 2 Overview of the DBT for IPV Treatment
Protocol. The DBT for IPV protocol is delivered in a group setting led by two co-therapists.
Handouts adapted from the DBT Skills Training: Handouts and Worksheets are provided to
clients in session, and homework is provided to help with the retention of the content.3 The
DBT for IPV protocol can be broken down into five overarching themes or concepts:
mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and
validation. These concepts form the foundation of the original 12-week closed model, the open
group model and the intensive two-day group.4-6 The open group focuses on one module per
session, where as the closed group and the two-day group start by introducing the
intervention's two foundational topics: mindfulness and behavioral chains. Each module covers
several concepts that link back to these two topics.
These five modules were designed to address the psychological sequelae frequently experienced
by victims of IPV, as well as to address the underlying mechanisms driving psychological
distress among victims of IPV. In addition to reducing revictimization by addressing mental
health problems, the DBT for IPV treatment paradigm provides clients with skills (i.e.
interpersonal effectiveness and validation) to improve their relationships and reduce the
occurrence of violence in their relationships.
Treatment adjuncts. While DBT has demonstrated success in treating a multiple psychological
issues, such as suicidal ideation, substance abuse, anger, emotional dysregulation and
distress tolerance, it is a costly and time-intensive intervention.7-11 However, research has
shown that treatment adjuncts, such as apps and websites, enhance treatment outcomes for a
various psychological disorders.12 Technology disseminated interventions have been shown to
effectively reduce symptoms of depression, PTSD and anxiety.13 In their review of mobile apps
for the treatment of mental disorder, Ameringen and colleagues (2017) noted that employing
technology-based interventions might reduce the need for in-person appointments with
clinicians, particularly for clients who encounter geographical, time, or financial
barriers.13 Further they concluded that apps improve treatment engagement with clinicians and
provide opportunities for clinicians to reinforce skills and concepts they taught their
clients in session.13 In addition to using treatment adjuncts to enhance treatment outcomes
above and beyond treatment as usual, therapists can use treatment adjuncts such as video
intervention adjuncts (VIAs), which deliver intervention content via multimedia, as a means
of reducing therapist burden.
Research Design and Rationale The objective of this study is to conduct a randomized control
trial (RCT) examining the implementation of VIAs, developed for the purpose of enhancing
skills generalization, acquisition, and (ultimately) treatment outcomes for DBT for IPV
skills group members. Stratified randomization (controlling for those who are court mandated
to treatment) will be used assigned participants to the experimental condition (the two-day
skills group + the VIAs) or a control condition (the two-day skills group only). The primary
outcomes are as follows: 1) investigate whether exposure to the VIA enhances treatment gains
above and beyond treatment as usual; 2) assess participant acceptability of the VIAs; and 3)
determine if participants in the experimental VIA condition will report a higher frequency of
using the skills over the follow-up period than those in the control condition. Following the
guidelines for developing and researching behavioral therapies, a Stage One Pilot Trial will
be conducted, focusing on feasibility, participant acceptability, and treatment outcome.14
Participants. Following the Onken, Carroll, Shoham, Cuthbert, and Riddle (2014) guidelines
for conducting clinical research, a Stage One Pilot Trial will be conducted.15 Stage 1-A is
modification or refinement of an existing intervention, and Stage 1-B is feasibility and
pilot testing. In this study, the existing intervention is the DBT for IPV skills workshop
and the modification is the addition of the VIAs. Because Stage One trials recommend 15-30
subjects per group, the study will require a sample N of 81 (assuming an attrition rate of
35% as reported in Lee and Fruzzetti's 2017 study) to meet the goal N of 60.
Screening and recruitment. Participants will include those who seek services through the
THRIVE Center. Community recruitment efforts will include advertising and contacting
connections at local community agencies and resource centers for victims of IPV (e.g.
temporary protection order offices, Reno Police Department, District Attorney offices, etc.).
Individuals interested in receiving treatment will complete intake measures prior to
beginning treatment to establish a baseline, at a one-month follow-up, and three-month
follow-up.
Intervention. The DBT for IPV skills protocol consists of five major interconnected topics:
mindfulness, emotion regulation, distress tolerance, validation, and interpersonal
effectiveness. The two-day skills group will be conducted on weekends to increase the
likelihood that participants will be able to attend. The skills group will be scheduled from
9am-4pm with a one-hour lunch break (lunch will be provided).
Experimental condition. Participants assigned to the experimental condition will receive a
text or email message approximately every two days with a link to a VIA hosted on the online
research platform Qualtrics. Each VIA reviews one of the core skills that was taught as part
of the two-day skills group. Participants will be asked questions regarding whether the VIA
helped them better understand the concept/skill, whether they enjoyed the VIA, and three
questions about the content (to serve as a manipulation check). A correct repose to two of
the three manipulation check questions will qualify the individual as having completed that
VIA.
Control Condition. Participants assigned to the control condition will receive the two-day
skills group without the VIAs.
efficacious cognitive behavioral treatments for disorders such as anxiety, depression, and
other emotion regulation difficulties, Linehan developed the framework for DBT.1 In addition
to these traditional CBT change-oriented techniques, which may leave clients feeling blamed
for their problems or situation, Linehan incorporated radical acceptance. Radical acceptance
emphasizes that self-compassion and acceptance (i.e. accepting how things really are rather
than how they 'should' be) are necessary for making meaningful changes. When operating from a
DBT framework the therapist's goal is to balance and synthesize acceptance and
change-oriented strategies. Individuals who have experienced IPV often struggle to accept
their situation (e.g. "But I love him," or "he said he will never do it again… although he
said that before") and often receive blame from others for their situation (e.g. "Why
wouldn't you just leave?"). Treating victims of IPV using a DBT framework allows victims to
learn skills to change their situation in a non-judgmental and validating environment.
In addition to providing victims with a validating environment, DBT aims to foster emotion
regulation, enhance interpersonal effectiveness, improve self-validation, and increase
distress tolerance. Mindfulness (i.e. present-moment awareness, acceptance, and participation
without judgment) is core to these skills and to DBT. 2 Overview of the DBT for IPV Treatment
Protocol. The DBT for IPV protocol is delivered in a group setting led by two co-therapists.
Handouts adapted from the DBT Skills Training: Handouts and Worksheets are provided to
clients in session, and homework is provided to help with the retention of the content.3 The
DBT for IPV protocol can be broken down into five overarching themes or concepts:
mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and
validation. These concepts form the foundation of the original 12-week closed model, the open
group model and the intensive two-day group.4-6 The open group focuses on one module per
session, where as the closed group and the two-day group start by introducing the
intervention's two foundational topics: mindfulness and behavioral chains. Each module covers
several concepts that link back to these two topics.
These five modules were designed to address the psychological sequelae frequently experienced
by victims of IPV, as well as to address the underlying mechanisms driving psychological
distress among victims of IPV. In addition to reducing revictimization by addressing mental
health problems, the DBT for IPV treatment paradigm provides clients with skills (i.e.
interpersonal effectiveness and validation) to improve their relationships and reduce the
occurrence of violence in their relationships.
Treatment adjuncts. While DBT has demonstrated success in treating a multiple psychological
issues, such as suicidal ideation, substance abuse, anger, emotional dysregulation and
distress tolerance, it is a costly and time-intensive intervention.7-11 However, research has
shown that treatment adjuncts, such as apps and websites, enhance treatment outcomes for a
various psychological disorders.12 Technology disseminated interventions have been shown to
effectively reduce symptoms of depression, PTSD and anxiety.13 In their review of mobile apps
for the treatment of mental disorder, Ameringen and colleagues (2017) noted that employing
technology-based interventions might reduce the need for in-person appointments with
clinicians, particularly for clients who encounter geographical, time, or financial
barriers.13 Further they concluded that apps improve treatment engagement with clinicians and
provide opportunities for clinicians to reinforce skills and concepts they taught their
clients in session.13 In addition to using treatment adjuncts to enhance treatment outcomes
above and beyond treatment as usual, therapists can use treatment adjuncts such as video
intervention adjuncts (VIAs), which deliver intervention content via multimedia, as a means
of reducing therapist burden.
Research Design and Rationale The objective of this study is to conduct a randomized control
trial (RCT) examining the implementation of VIAs, developed for the purpose of enhancing
skills generalization, acquisition, and (ultimately) treatment outcomes for DBT for IPV
skills group members. Stratified randomization (controlling for those who are court mandated
to treatment) will be used assigned participants to the experimental condition (the two-day
skills group + the VIAs) or a control condition (the two-day skills group only). The primary
outcomes are as follows: 1) investigate whether exposure to the VIA enhances treatment gains
above and beyond treatment as usual; 2) assess participant acceptability of the VIAs; and 3)
determine if participants in the experimental VIA condition will report a higher frequency of
using the skills over the follow-up period than those in the control condition. Following the
guidelines for developing and researching behavioral therapies, a Stage One Pilot Trial will
be conducted, focusing on feasibility, participant acceptability, and treatment outcome.14
Participants. Following the Onken, Carroll, Shoham, Cuthbert, and Riddle (2014) guidelines
for conducting clinical research, a Stage One Pilot Trial will be conducted.15 Stage 1-A is
modification or refinement of an existing intervention, and Stage 1-B is feasibility and
pilot testing. In this study, the existing intervention is the DBT for IPV skills workshop
and the modification is the addition of the VIAs. Because Stage One trials recommend 15-30
subjects per group, the study will require a sample N of 81 (assuming an attrition rate of
35% as reported in Lee and Fruzzetti's 2017 study) to meet the goal N of 60.
Screening and recruitment. Participants will include those who seek services through the
THRIVE Center. Community recruitment efforts will include advertising and contacting
connections at local community agencies and resource centers for victims of IPV (e.g.
temporary protection order offices, Reno Police Department, District Attorney offices, etc.).
Individuals interested in receiving treatment will complete intake measures prior to
beginning treatment to establish a baseline, at a one-month follow-up, and three-month
follow-up.
Intervention. The DBT for IPV skills protocol consists of five major interconnected topics:
mindfulness, emotion regulation, distress tolerance, validation, and interpersonal
effectiveness. The two-day skills group will be conducted on weekends to increase the
likelihood that participants will be able to attend. The skills group will be scheduled from
9am-4pm with a one-hour lunch break (lunch will be provided).
Experimental condition. Participants assigned to the experimental condition will receive a
text or email message approximately every two days with a link to a VIA hosted on the online
research platform Qualtrics. Each VIA reviews one of the core skills that was taught as part
of the two-day skills group. Participants will be asked questions regarding whether the VIA
helped them better understand the concept/skill, whether they enjoyed the VIA, and three
questions about the content (to serve as a manipulation check). A correct repose to two of
the three manipulation check questions will qualify the individual as having completed that
VIA.
Control Condition. Participants assigned to the control condition will receive the two-day
skills group without the VIAs.
Inclusion Criteria:
- Victim of domestic violence
- Must be 18 years old or older
- Speak English
- Have a 8th grade reading level
- Be a female
- Have access to the internet
Exclusion Criteria:
- People who are suicidal
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