|Year : 2015 | Volume
| Issue : 1 | Page : 1-7
The effectiveness of dialectical behavior therapy and rational emotive behavior therapy in irrational believes treatment, anxiety among young male prisoners who have antisocial personality disorder in Ilam prison
Parisa Asmand, Shahram Mami, Reza Valizade
Department of Psychology, Branch, Islamic Azad University of Ilam, Ilam, Iran
|Date of Web Publication||17-Dec-2014|
Department of Clinical Psychology, Branch, Islamic Azad University of Ilam, Ilam
Source of Support: None, Conflict of Interest: None
Antisocial personality have some clear symptoms as impulsivity, unstable emotions, aggression, drinking, use of drug, early initiation of sexual behavior making some difficulties and problems in their relationship with family members and those who have interaction with them and at least in the society. According to the mentioned symptoms of this personality disorder in the present research, it has been tried to solve these problems by comparing with the effectiveness of dialectical behavior therapy (DBT) and rational emotional behavior therapy (REBT) in irrational treatment, anxiety among young male prisoners who have antisocial personality in Ilam prison. The present semi-experimental project has been done by pretest and posttest selected purposely 64 subjects that have been selected purposely between 18 and 40 years among male prisoners in Ilam prison. Three questionnaires have been used, which are as follow: Millon Clinical Questionnaire, Johns Irrational Beliefs and Back Anxiety Questionnaire. In the study of the effectiveness of the therapies, the results showed that DBT has affected on all irrational beliefs (P < 0.05) and REBT only has affected on changing some beliefs. There is not also a significant difference between pretest and posttest scores for treating the anxiety but, DBT is more efficient than REBT. According to the findings obtained appears to be a dialectical therapy, therapeutic efficacy. Is more efficient than REBT in irrational believes treatment, anxiety people with antisocial personality disorder.
Keywords: Antisocial personality disorder, Dialectical behavior therapy, rational emotional behavior therapy
|How to cite this article:|
Asmand P, Mami S, Valizade R. The effectiveness of dialectical behavior therapy and rational emotive behavior therapy in irrational believes treatment, anxiety among young male prisoners who have antisocial personality disorder in Ilam prison. Int J Health Syst Disaster Manage 2015;3:1-7
|How to cite this URL:|
Asmand P, Mami S, Valizade R. The effectiveness of dialectical behavior therapy and rational emotive behavior therapy in irrational believes treatment, anxiety among young male prisoners who have antisocial personality disorder in Ilam prison. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2019 Dec 14];3:1-7. Available from: http://www.ijhsdm.org/text.asp?2015/3/1/1/147135
| Introduction|| |
Personality is an organized and unit structure including some relative permanent characteristics, which distinct individuals from each other (Laurent, 2008) If personal characteristics are inflexible and have outside social norms  personality disorder diagnosis is proponed (Jazayeri, 2003)  (Azadeh, 2007).  Personality disorder is a permanent pattern of internal experiment and behavior, which contradicts with the cultural expectation excessively that is started during the adolescence period. This manner is a constant one which leads to a disorder or mental disturbance (Diagnostic and Statistical Manual of Mental Disorder IV-Tree Revise [DSM-IV-TR]). Personality disorder is one of the chronic and common disorders  which is speeded among 5-10% of the general population.  According to DSM-IV-TR, mental disorders are classified into three groups. The first one is personality disorder cluster B, which antisocial personality disorder is one of its subgroups (Hoseini, 2008)  which is more concentrated on, due to the criminal behaviors.  This is a complex disorder, which has the following features: Sever lack of interest,  Reckless disregard to safety of self or others (Frederick, 2005) flippancy and flattery and the ability of playing with other people, feeling lack of exciter and causeless manner and impulsive behaviour (Gholamloo, 2009),  disability of learning or experiment function, disturbed interpersonal relationships, lack of conscience,  repentance of irresponsible behaviors (Yousefi, 2009),  perverted reactions and conditioning toward punishment, robbery, telling lies, argument, going away from home and school,  insubordination and mutiny  and drug abuse (National Institute for Health and Clinieal Exllence [NICE], 2009).  In this group, sexual behaviors are beginning earlier than other people. Alcohol, drug abuse (Akbari, 2008)  and quarreling  are also other characteristics of this group. These behaviors are long lasting in the young too. In this period, instability of occupation and irresponsibility of family management, incompatibility toward the society regulations are added to the aforementioned behaviors too (Khademi, 2009)  which are related to family factors and relationships (NICE, 2009),  life condition,  parenting method, etc.  This disorder which is common among 3% of men 1% of women (Frederick, 2005) (NICE, 2009)  is of two categories: With anxiety and without anxiety deception, aggression and impulsive behaviors are common in the group with anxiety. Robbery, lack of regret and weapon use are common in group without anxiety (Beigdeli, 2011). Improper cognitive and ultra-cognitive beliefs about themselves and their personality include no balance between their positive and negative dimensions (Khademi, 2012).  Therefore, those people who have antisocial personality are one dimensional regarding different fields, which is the dimension that satisfies their personal profits. Naturally, such a personality characteristics produce many problems for other people who have a relationship with these characters, so their surrounding is motivated to find a therapy. Hence, according to these characteristics, the therapist should engage the patient with suitable thought and behaviors and reduce the egotism and being absolute of their behaviors the first step. So, it is necessary to direct and organize the therapy process to carry out the mentioned factors. Cognitive therapy can be considered as a proper scientific therapy is a thorough one in spite of carried out studies (Akbari, 2009)  one of the cognitive therapy is dialectical behavior therapy (DBT) which was introduced in 1993 by Marsha Linhan (Ebrahimi and Reza, 2008)  which acts as cognitive therapy.  At first, this therapy was used for borderline personality disorder which its effectiveness is confirmed by American Psychiatrist Association (Lynch, 2003).  Since the therapy program is a structural and has a simple function for the therapist, it is considered as a useful therapy for other personality disorder therapy according to carried out studies (Soler, 2009)  (Hammadi, 2012) which has a successful function in the therapy of disorder especially nervous eating,  drug abuse,  attention deficit hyperactivity disorder,  people with suicide thought , depression , disturbance of mind and stress reduction (Kroger, 2006).  Another therapy, that is introduced by Albert Alice (Vernon, 2010) is rational emotional behavior therapy (REBT) based on cognitive behavior therapy (Groth, 2010). Internal factors of individuals are referred as a cognitive therapy (Proucheska, 2007), he believes that the activating events are not important, but the beliefs and deduction of events by people are important. It means that this is our deduction which has some consequences. So, this therapy can be useful as a determining and informative factor , (Proucheska, 2007). Then with regarding to the importance of the issue (properties of the persons having antisocial personality disorder and involvement of the person, family and finally the society), and with regarding to this fact that there have not been any exact investigations about affirmed efficiency disorder of the mentioned therapy in treating the same disorders as antisocial personality and his history, based on done studies in information station of journals (Pupmed.gov, Psynet.apa.org). The aim of this study is the study of the effectiveness of DBT and REBT in irrational treatment, anxiety among young male prisoners who have antisocial personality in Ilam prison, according to the importance and effectiveness of the mentioned method therapies in the same disorder therapy.
| Methods|| |
This is an semi-experimental study which has pretest and posttest including control and two experimental group. The item but different from cells DBT and REBT and irrational believes treatment, anxiety is dependent variable. The study selected purposely was 64 people selected purposely among the prisoners of Ilam prison aging between 18 and 40 ages. In year 2013 they were recognized as an antisocial person by psychologist after Millon test and the interpretation of test and a structured clinical interview for DSM-IV-II whose conviction period lasts at least next 1 year. And exclusion criteria and absence of noncompliance it is mentioned more than twice. The specimens were randomly assigned to treatment groups of 16 persons consisted of DBT and REBT group and one control group. And at the beginning of each test anxiety, irrational beliefs and to compare anxiety and irrational beliefs in individual sessions were taken. And test each class individually with each of the 16 sessions of 1 h of work, of these 48 individuals, because of the lack of cooperation of some samples and absent prison and more than two sessions finally, research collaborations involving 48 patients in the experimental group and cooperate fully in the meetings ended notably, the application of treatments based on the original protocol DBT for borderline personality disorder, were little changed and approved by the relevant faculty researcher with the main focus control accreditation and REBT thought process orientation with a focus on cognitive distortions has been performed. It also should be noted that 20 days after the first therapy session, control and test groups were tested as posttest of the related questionnaires, their results have been mentioned in finding section. For ensuring the correct answers, controlling the conditions and also preventing from inserting similar answer based on the previous mentality, it was tried to provide a calm environment for the testers to answer the questions results are analyzed by the software SPSS version 21.
Millon Clinical Multiaxial Inventory III:  This questionnaire contains 175 true-false questions, which includes three credit scales,  10 clinical personality pathology, six clinical symptoms scales and three severe symptoms  reliability, retesting, internal uniformity and the validity of foreign studies and in Iran are reported as follow: Final coefficient 85%, retesting coefficient 86% (Garoosi and Taghi, 2006). 
Back/Beck Anxiety Questionnaire: This questionnaire was introduced in 1988 by Beck et al. which ranks the severity of each sing as a four scale grade from (never) to (I can't stand it). The process of scoring is carried out by the addition of all scores that is between 0 and 63.  The reliability of the questionnaires is identified as 75% by the use of retesting method on 83 patients. The validity, reliability and the internal constancy of the study are 72%, 83% and 92% respectively.  According to these studies, the interval constancy of this test is 86%. 
Jones illogical beliefs questionnaire: Illogical beliefs measurement and assessment of Jones illogical beliefs questionnaire is used based on Albert Alice idea (1969). This questionnaire includes 100 questions that have 10 subscales. Each subscale has got 10 questions. The ranking of the questions is done based on Likert five scales method. In this type of questionnaire, the subjects identify his/her agreement or disagreement as follow: (Quite disagree, relative disagree, no idea, relative agree, quite agree). There is a key to score each scale. The above score determines the severity of illogical beliefs. Total score of illogical beliefs is obtained by the addition of all subscales. The above scores show that the numbers of illogical beliefs are more than a logical one. The total validity of the questionnaire and each of the subscales is 92% and 66-80% respectively by Jones in 1962 employing testing method. The validity of this questionnaire is reported as 68% by Taghipoure (2008), 68% by Dandi (1998), 79% by Vaziri (1996) and 82% by Lotfi (1997) using Chronbakh investigating the reliability of convergent correlation between this questionnaire and depression, Dotapoush obtained 82% as correlation coefficient (Aminpoor, 2008). 
| Results|| |
According to results descriptive statistical, which describes some of the characteristics of the statistical society of this study, the age average of them is 20-25 whose frequency is 37.5% in dialectic group and 50% in rational emotive group. According to this table most of the prisoners take parts in this study, are single whose frequency is 100% and 75% in DBT and REBT respectively. More than 80% of them experienced prison for the second time whose education level is diploma that is 37.5% in both groups 31.2% of two groups are drug addicted. Regarding job and occupation, most of them are businessman and seller which are 56.2% and 50% in DBT and REBT groups, respectively.
The results of [Table 1] which studies the illogical beliefs between DBT and REBT in antisocial personality disorder youngsters', which according to one direction variance and the normal distribution of grades according to Kolmogorov-Smirnov test for making comparison between two groups, it shows there is no uniformity in two subscales of illogical beliefs among subjects of DBT and REBT groups as there is no significant difference between "need to high degree of confirmation" and "helplessness to changes" which shows the uniformity of these two subscales. The results of comparison between two groups of DBT and REBT show that there are no meaningful differences among to subscales (P ≥ 0.05) and it just shows lack of difference among subjects after the therapy cycle. A comparison of the effectiveness levels of therapy cycle is presented.
|Table 1: One-way ANOVA between treatment groups for the study of irrational beliefs REBT and DBT|
Click here to view
In [Table 2] according to three results and t-test and the comparison of the effectiveness of two therapies (DBT and REBT) on illogical beliefs of antisocial personality disorder youngsters, the effectiveness of DBT on illogical beliefs subscales is more, since it has a meaningful effect on all the subscales (P ≤ 0.05). Results of the effectiveness of rational REBT is something different, since it has a meaningful effect just on tendency to reproach (significant = 0.16), reaction to failure (significant = 0.32) and disability toward changes (significant = 0.32). The effectiveness of its meaningfulness high expectation of us and irresponsibility after rational REBT is discussable which shows the meaninglessness of the therapy.
|Table 2: T-test the effectiveness of DBT and REBT in irrational believes treatment|
Click here to view
In [Table 3] it can be said that there is no difference in anxiety level. So, the meaningfulness level (0.97) shows the uniformity of studied groups. The results of posttherapy are the same and there are no differences between these two groups. The meaningfulness level (0.44) of postcycle shows that the effectiveness of subjects is as that there is no meaningful difference, which doesn't represent the in effectiveness of therapies.
The results of t-test are presented in [Table 4], which study the effectiveness of the therapies shows that DBT has a meaningful effect on anxiety level (0.14). However, the effectiveness of REBT is not meaningful, which are shown by the results (0.158). Although, there is a numerical raise between the last average (32.75) and the present one (29.81).
|Table 4: Depended t-test the comparison of efficacy in the treatment of test anxiety in both groups|
Click here to view
| Discussion|| |
The present study aims at an investigation into the effectiveness of DBT and REBT in Illogical beliefs therapy, anxiety and depression of antisocial personality disorder among male population of Ilam prison. According to results descriptive statistical, it can be concluded that some of the characteristics like addiction (NICE, 2007)  (Ghoddoosi, 2001)  and criminal behaviour.  The results of this study could be explained that, since antisocial personality disorder is diagnosed after the age of 18 also under investigation with regard to the level of criminal behavior, antisocial individuals decreased with increasing age (Bacher, 2010). Findings could be due to the greater accuracy of the sample group aged 20-25 years are the most prominent building. And, according to the characteristics of school leaving (Yousefi, 2010).  People with antisocial personality disorder, low education level and lack of academic education could be observed in this study skins lead to imprisonment the results of [Table 1] which studies the illogical beliefs between DBT and REBT in antisocial personality disorder youngsters, it shows there is no uniformity in two subscales of illogical beliefs among subjects of DBT and REBT groups as there is no significant difference between "need to high degree of confirmation" and "helplessness to changes" which shows the uniformity of these two subscales. The results of the comparison between two groups of DBT and REBT show that there are no meaningful differences among to subscales and it just shows lack of difference among subjects after the therapy cycle. The comparison of the effectiveness levels of therapy cycle is presented in [Table 2]. The effectiveness of DBT on illogical beliefs subscales is more, since it has a meaningful effect on all the subscales. Results of the effectiveness of rational REBT is something different, since it has a meaningful effect just on tendency to reproach, reaction to failure and disability toward changes. The effectiveness of its meaningfulness high expectation of us and irresponsibility after rational REBT is discussable, which shows the meaninglessness of the therapy. These results are consistent with results (Riahi, 2010). Explaining the results come from REBT, it can be said that it seems that the courses which were taught to subjects about illogical beliefs are more complex than those which change the clients in a short period of time. In other words, clients must interoperate courses, judge them, accept them and finally apply them which need a long process to be efficient. According to Alice, these beliefs can become permanent and constant when people act according to their illogical beliefs. It acts automatically in hard situations and don't allow people act according to their new and logical acquired beliefs. So, if people want to replace illogical beliefs with the logical one, they will need practice and a period of time, since antisocial personality accompanied by depression (Curwen, 2000). The comparison of anxiety before therapy cycle in two groups of DBT and REBT, with the results and normal distribution of scores are presented explaining the results obtained from DBT on the irrational beliefs of the sample persons, it can be said that with regarding to the effect of the irrational beliefs on the negative emotions of the person and also with regarding to this fact that the persons having antisocial personality disorder are so adherent in [Table 3]. It can be said that there is no difference in anxiety level. So, the meaningfulness level shows the uniformity of studied groups. The results of posttherapy are the same and there are no differences between these two groups. The meaningfulness level of postcycle shows that the effectiveness of subjects is as that there is no meaningful difference which does not represent the in effectiveness of therapies. The results of t-test are presented in [Table 4], which study the effectiveness of the therapies shows that DBT has a meaningful effect on anxiety level. However, the effectiveness of REBT is not meaningful which are shown by the results. Although there is a numerical raise between the last average and the present one results of this investigation are consistent with the results of Salehi in 2011 in a study entitled "effect of emotion adjustment based on Grass process model and DBT on the emotional problem's symptoms. Also in a comparative study, the results of the present study aren't consistent with other recognition investigations and the results of (Weinberg, 2004), (Dividson, 2007), (Libe, 2004), (Gunderson, 2000). Explaining the results of the present study, it can be said that antisocial personality disorder accompanied by anxiety (Beigdeli, 2011) (Tomasson, 2000). It can be said antisocial personality disorder is of two types: With anxiety and without anxiety. , the slight differences of s 3 and 4 are reasonable. So with regard to the results and explain identification results could be said to have been taken in accordance with that antisocial personality disorder is associated with anxiety (Bigdeli, 2009)  (Tomas, 2000). This is also evident in the statistical sample is an individual, so with regard to the particular circumstances of the statistical community, the tensions and stresses of every moment of the order of those offenses, the execution connective and Masaeli category stresses contributed to the high environmental and ultimately may lead to a chronic anxiety in the person, so it can safely be said with regard to the above. I venture to say that the high anxiety and lack of effective short-term treatment occurred in patients with such personality traits and environmental groups, the expected off is not a subjective.
Mentioned and also consider the fact that people with antisocial personality disorder in people who are susceptible repeatedly throughout their lives according to their personality traits felt they rejection with regard to the content dialectical therapy, therapeutic is more efficient than REBT in the treatment of some of the characteristics of people with antisocial personality disorder.
Like the other studies, this investigation has some limitations:
No proper and special space for holding the therapy sessions, special issues of the imprisons which sometimes resulted in irregular therapy sessions, special issues of each sample whose continuous presence created some problems, limited access to the therapy protocol which is suitable for the type of disorder and applied therapies, small number of the statistical sample because of limitations and nonpredicted problems in the statistical society.
With regarding to the limitations of the investigation which can be effective on nonefficiency of some therapy results, it is recommended to do the therapy in the conditions with the most desirable assistance.
| Acknowledgment|| |
I would like to express my gratefulness to all managers of the prisons and the social workers who agreed upon to cooperate as the investigation sample and all other persons who helped us in this study.
| References|| |
Armand W. Assessment and diagnosis of personality disorders. The ICD-10 international personality disorder examination(IPDE) 1997; published by the press syndicate of the university of Cambridge.
Jazayeri A. Evaluation and comparison of the relationship between the individual components and coping strategies for addicted. J Addict Stud (2003), NO:7 , 340-345.
Azad H. Psychopathology. Volume 1. 10 th
edition. Tehran: Besat; 2007.
Clarkin JF, Levy KN, Lenzenweger MF, and Kernberg OF. Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 2007;164:922-8.
Svrakic DM, Draganic S, Hill K, Bayon C, Przybeck TR, Cloninger CR. Temperament, character, and personality disorders: Etiologic, diagnostic, treatment issues. Acta Psychiatr Scand 2002;106:189-95.
Hoseini FF. Decision making under risk assessment in patients with borderline personality disorder and antisocial. J Ment Health 2009;(2):95-104.
Maj M, Akiskal HS, Mexxich JE, Okasa A. Personality Disorders. 5 th
ed., Vol. 125. London: John Wiley Andsons; 2007.
Narud K, Mykletun A, Dahl AA. Therapists′ handling of patients with cluster B personality disorders in individual psychotherapy. Compr Psychiatry 2005;46:186-91.
Gholamloo J. The Study of the Criminology of serial murder phenomenon/ MA thesis of criminal law. J Med Law 2011;(16):134-47.
Ghoddoosi A. Factors in patients with schizophrenia compared to Crime and antisocial personality disorder. Leg Med J 2002;(28):5-9.
Yousefi M. Personality disorder. J Happiness Success 2009;(82):46-48.
National Institute for Health and Clinieal Exllence. Antisocial Personality Disorder. Treatment, management and prevention: NICE; 2009.
Akbari J. Effectiveness of cognitive behavioral and pharmacological treatment of anxiety and impulsivity in men with borderline personality disorder. J Ment Health 2008;(40):317-23.
Donald W, Black MD. Bad Boy Bad Men. Confronting Antisocial Personality Disorder (Sociopathy); 2013.
khademi A, Seif AA. Effects of cognitive training component in reducing anti social behavior among young prisoners in Orumieh. J Behav Sci 2011;(3):186-96.
Ebrahimi M, Reza ET. Prevalence of personality disorders among runaway soldiers referred to the hospital. J Iran Army 2008;(1):35-9.
Alavi KH, Modares M. Effi cacy of DBT group style (based on the fundamental components of pervasive awareness, distress tolerance, and emotional regulation) on depressive symptoms in students the Asvl. Ment Health J 2011;(2):35-124.
Lynch TR, Morse JQ, Mendelson T, Robins CJ. Dialectical behavior therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry 2003;11:33-45.
Soler J, Pascual J, Tiana T, Barrachina J, Gich I, and Alvarez E. Dialectical behavior therapy skills training compared to standard group therapy in borderline personality disorder. Behaviour Research and therapy. (2009).47: 335-58.
Telch CF, Agras WS, Linehan MM. Dialectical behavior therapy for binge eating disorder. J Consult Clin Psychol 2001;69:1061-5.
Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P, et al.
Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend 2002;67:13-26.
Hesslinger B, Tebartz van Elst L, Nyberg E, Dykierek P, Richter H, Berner M, et al.
Psychotherapy of attention deficit hyperactivity disorder in adults - A pilot study using a structured skills training program. Eur Arch Psychiatry Clin Neurosci 2002;252:177-84.
Katz LY, Cox BJ, Gunasekara S, Miller AL. Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. J Am Acad Child Adolesc Psychiatry 2004;43:276-82.
Linehan M. Evidence Based Practices Panel Report on Dialectical Behavior Therapy. USA (Montpelier): Vermont Council of Developmental and Mental Health Services; 2006.
Kroger C, Schweiger US, Valerija A, Ruediger K, Rudolf S, and Reinecker H. Effectiveness of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and therapy 2006.44: 1211-7.
Asaii SH. The Efficacy of Group Psychotherapy Approach to Intellectual, Emotional, and Behavioral Depression and Addiction, and Treatment of the First National Conference on Psychology; 2012.
Naja M. In his Thesis Titled Ellis REBT Techniques to Increase the Effectiveness of EI Training Young Offenders Kermanshah Central Prison, End of the Letter; 2008.
Millon T, Davis RD. The MCMI-III: Present and future directions. J Pers Assess 1997;68:69-85.
Sharifi A. Mellon multiaxial diagnostic validity. J Knowl Res Psychol Isfahan Univ 2007;(1-2):124-30.
Garoosi F, Taghi M. Comparison of the Personality traits and coping styles of offenders′ and normal subjects. J Contemp Psychol 2006;(3):65-69.
Salvati M. Effectiveness of Schema Therapy on Women with Borderline Personality Disorder. Psychiatric, Institute. Thesis; 2007.
Kaviani H. Psychometric properties of the Beck Anxiety Inventory age and sex classes of the population of Iran. Tehran Univ Med Sci J 2008;(2):126-40.
Poor HH. The Efficacy and Effectiveness of Cognitive Therapy in the Treatment of Depression/MA Thesis. Ferdowsi University; 2005.
Aminpoor HA. Evaluation and Comparison of irrational beliefs in addicts and normal people. Addict Journal of Research on Addiction 2008;3:107-19.
Karpman B. On the need of separating psychopathy into two distinct clinical types: The symptomatic and the idiopathic. J Criminol Psychopathol 1941;8:112-37.
Ullrich S, Coid J. Antisocial personality disorder - Stable and unstable subtypes. J Pers Disord 2010;24:171-87.
Bigdeli I. Personality disorder subtypes of social anxiety and its relationship with drug abuse. J Clin Psychol 2009.
[Table 1], [Table 2], [Table 3], [Table 4]