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Veterans are at high risk for suicide; emotion dysregulation may confer additional risk. Dialectical behaviour therapy (DBT) is a well-supported intervention for suicide attempt reduction in individuals with emotion dysregulation, but is complex and multi-component. The skills group component of DBT (DBT-SG) has been associated with reduced suicidal ideation and emotion dysregulation. DBT-SG for Veterans at risk for suicide has not been studied. This study sought to evaluate the feasibility and acceptability of DBT-SG in Veterans and to gather preliminary evidence for its efficacy in reducing suicidal ideation and emotion dysregulation and increasing coping skills. Veterans with suicidal ideation and emotion dysregulation (N = 17) enrolled in an uncontrolled pilot study of a 26-week DBT-SG as an adjunct to mental health care-as-usual. Veterans attended an average 66% of DBT-SG sessions. Both Veterans and their primary mental health providers believed DBT-SG promoted Veterans' use of coping skills to reduce suicide risk, and they were satisfied with the treatment. Paired sample t-tests comparing baseline scores with later scores indicated suicidal ideation and emotion dysregulation decreased at post-treatment (d = 1.88, 2.75, respectively) and stayed reduced at 3-month follow-up (d = 2.08, 2.59, respectively). Likewise, skillful coping increased at post-treatment (d = 0.85) and was maintained at follow-up (d = 0.91). An uncontrolled pilot study indicated DBT-SG was feasible, acceptable, and demonstrated potential efficacy in reducing suicidal ideation and emotion dysregulation among Veterans. A randomized controlled study of DBT-SG with Veterans at risk for suicide is warranted.

Background Communication between patients and providers about persistent “medically unexplained” physical symptoms (MUS) is characterized by discordance. While the difficulties are well documented, few studies have examined effective communication. We sought to determine what veterans with Gulf War Illness (GWI) perceive as the most helpful communication from their providers. Veterans with GWI, a type of MUS, have historically had complex relationships with medical providers. Determining effective communication for patients with particularly complex relationships may help identify the most critical communication elements for all patients with MUS. Methods Two hundred and-ten veterans with GWI were asked, in a written questionnaire, what was the most useful thing a medical provider had told them about their GWI. Responses were coded into three categories with 10 codes. Results The most prevalent helpful communication reported by patients was when the provider offered acknowledgement and validation (N = 70). Specific recommendations for managing GWI or its symptoms (N = 48) were also commonly reported to be helpful. In contrast, about a third of the responses indicated that nothing about the communication was helpful (N = 63). There were not differences in severity of symptoms, disability or healthcare utilization between patients who found acknowledgement and validation, specific recommendations or nothing helpful. Conclusions Previous research has documented the discord between patients and providers regarding MUS. This study suggests that most patients are able to identify something helpful a provider has said, particularly acknowledgement and validation and specific treatment recommendations. The findings also highlight missed communication opportunities with a third of patients not finding anything helpful.

Arguments have been made for dimensional models over categorical for the classification of personality disorder, and for the five-factor model (FFM) in particular. A criticism of the FFM of personality disorder is the absence of measures designed to assess pathological personality. Several measures have been developed based on the FFM to assess the maladaptive personality traits included within existing personality disorders. One such example is the Five-Factor Obsessive-Compulsive Inventory (FFOCI). The current study applied item response theory analyses (IRT) to test whether scales of the FFOCI are extreme variants of respective FFM facet scales. It was predicted that both the height and slope of the item-response curves would differ for the conscientiousness-based scales, due to the bias towards assessing high conscientiousness as adaptive in general personality inventories (such as Goldberg’s International Personality Item Pool; IPIP). Alternatively, the remaining FFOCI scales and their IPIP counterparts were predicted to demonstrate no significant differences in IRCs across theta. Nine hundred and seventy-two adults each completed the FFOCI and the IPIP, including 377 undergraduate students and 595 participants recruited online. A portion of the results supported the hypotheses, with select exceptions. Fastidiousness and Workaholism demonstrated the expected trends, with the FFOCI providing higher levels of fidelity at the higher end of theta, and the IPIP demonstrating superior coverage at the lower end of theta. Other conscientiousness scales failed to demonstrate the expected differences at a statistically significant level. In this context, the suitability of IRT in the analysis of rationally-derived, polytomous scales is explored.