Criminal Behaviour and Mental Health

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Volume 29 Issue 2 (April 2019), Pages 69-130

Dialectical behaviour therapy (DBT) for forensic psychiatric patients: An Italian pilot study (pages 122-130)

  • Author(s): Valeria Bianchini, Vincenza Cofini, Martina Curto, Brunella Lagrotteria, Agostino Manzi, Serena Navari, Roberta Ortenzi, Giovanna Paoletti, Enrico Pompili, Pieritalo Maria Pompili, Cristiana Silvestrini, Giuseppe Nicolò
  • Published 15 Jan 2019
  • DOI: 10.1002/cbm.2102

Abstract Background Several previous randomised controlled trials of dialectical behaviour therapy (DBT) since Linehan's original have shown that it has an advantage over standard care or other psychological treatments, but focus is usually on suicide‐related behaviours, and little is known about its effect with offender‐patients. Aims To evaluate DBT with a group of offender‐patients in the Italian high intensity therapeutic facilities—the Residenze per l'Esecuzione delle Misure di Sicurezza (REMS), established under the Italian Law 81/2014. Methods Twenty‐one male forensic psychiatric in‐patients with borderline personality disorder were enrolled and randomly assigned to 12 months of standard DBT together with all the usual REMS treatments (n = 10) or usual REMS treatments alone (n = 11). All participants completed the same pretreatment and posttreatment assessments, including the Barratt Impulsiveness Scale (BIS‐11), Difficulties in Emotion Regulation Scale (DERS), and Toronto Alexithymia Scale 20 (TAS‐20). Results Men receiving DBT showed a significantly greater reduction in motor impulsiveness, as measured by the BIS‐11, and emotional regulation, as reflected by the DERS total score, than the controls. There were no significant differences between groups in alexithymia scores. Conclusions Italy has innovative forensic psychiatric facilities with a new recovery–rehabilitation approach, but the ambitious goals behind these cannot be achieved by pharmacology alone. For the first time in clinical forensic settings in Italy, there has been limited access to DBT. This small pilot study suggests this is likely to help ameliorate traits associated with violent and antisocial behaviours, so a full‐scale randomised controlled trial should follow.

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