Living Through Distress Programme

Living Through Distress (LTD) is a Dialectical Behaviour Therapy (DBT) informed, group-based intervention. The programme aims to provide emotional regulation, distress tolerance and mindfulness skills for individuals with problems of emotional under-control who frequently present with self-harmful behaviours. Linehan (1993a) proposed that emotional dysregulation underlies much maladaptive coping behaviour. Research suggests that behaviours such as deliberate self-harm (DSH) may function as emotion regulation strategies (Chapman et al., 2006).

Linehan’s bio-social theory posits that difficulties with emotional under-control are disorders of self-regulation arising from a skills deficit. Emotional regulation difficulties result from biological irregularities combined with certain dysfunctional environments, as well as from the interaction between them over time (Linehan, 1993a). Dialectical Behaviour Therapy informed interventions are described in a Cochrane review (2009) as effective evidence based interventions for DSH behaviours, emotional under-control difficulties and Borderline Personality Disorder.

Skills which aid patients to regulate their emotions are at the core of LTD. LTD focuses on both change and acceptance skills. The content is informed by Linehan’s skills-based group intervention and has been modified to meet the needs of the organisation, based on clinical research on the efficacy of the group. Further skills such as interpersonal effectiveness skills are introduced in a once monthly Aftercare programme.

The format of the Living Through Distress skills group has changed since September, 2016. Level 1 of the programme provides 18 skill-group sessions, three times a week for 6 weeks. These sessions aim to focus on teaching mindfulness, distress tolerance and emotion regulation skills. Following these 18 sessions, the programme has introduced a 16-week Level 2 intervention for those who complete Level 1. Level 2 is now exclusively a day patient programme and is focused on building a life worth living and facilitating patients in generalising their use of skills beyond the hospital setting. These 16 sessions aim to address emotion regulation and interpersonal effectiveness in more depth.

The department has undertaken research relating to the programme since it commencement and the measures being used have changed over time and continue to evolve. Previous research conducted with LTD attendees has demonstrated that participants show significant reductions in reported deliberate self-harmful behaviours and increases in distress tolerance skills (Looney & Doyle, 2008). In another study, those who attended LTD showed greater improvements in DSH, anxiety, mindfulness, and aspects of emotion regulation than people receiving treatment as usual. Further analysis showed that group process/therapeutic alliance and changes in emotion regulation were related to reductions in DSH (Gibson, 2011).