Dr. Kim Gratz

Description of Dr. Gratz’s Clinical Research Interests:

Dr. Gratz’s clinical and research interests focus on the role of emotion dysregulation and experiential avoidance in borderline personality disorder (BPD) and deliberate self-harm. In particular, her research focuses on understanding the nature and consequences of emotional dysregulation and avoidance in BPD and self-harm (through the use of novel behavioral/experimental paradigms), and applying this understanding to the development of innovative treatments for these conditions. Current projects include: (1) experimental investigations of emotion dysregulation and emotional avoidance in BPD and antisocial personality disorder; (2) an experimental investigation of the role of distress intolerance and impulsivity in self-harm behavior, including the moderating role of interpersonally-related distress in this relationship; (3) development of a longitudinal study examining the factors associated with BPD-related pathology and behaviors among children and adolescents; and (4) further development of her acceptance-based, emotion regulation group therapy for self-harm behavior among women with BPD.

Abstract of Dr. Gratz’s Paper:
“Preliminary Data on an Acceptance-Based Emotion Regulation Group Intervention for Deliberate Self-Harm among Women with Borderline Personality Disorder”

Borderline personality disorder (BPD) and deliberate self-harm are clinically-important conditions for which additional economically and clinically feasible interventions are needed. Literature on both the emotion regulating and experientially avoidant function of self-harm and the role of emotional dysfunction in BPD provided the rationale for developing a group intervention targeting emotion dysregulation among self-harming women with BPD. This study provides preliminary data on the efficacy of this new, 14-week, emotion regulation group intervention, designed to teach self-harming women with BPD more adaptive ways of responding to their emotions so as to reduce the frequency of their self-harm behavior. Participants were matched on level of emotion dysregulation and lifetime frequency of self-harm and randomly assigned to receive this group in addition to their current outpatient therapy (N=12), or to continue with their current outpatient therapy alone for 14 weeks (N=10). Results indicate that the group intervention had positive effects on self-harm, emotion dysregulation, experiential avoidance, and BPD-specific symptoms, as well as symptoms of depression, anxiety, and stress. Participants in the group treatment condition evidenced significant changes over time on all measures, and reached normative levels of functioning on most. While these preliminary results are promising, the study’s limitations require their replication in a larger-scale randomized controlled trial.

Biographical Information:

Dr. Gratz is Research Assistant Professor and Director of the Personality Disorders Division of the Center for Addictions, Personality, and Emotion Research (CAPER) in the Department of Psychology at the University of Maryland. Dr. Gratz received her Ph.D. in Clinical Psychology from the University of Massachusetts Boston in 2003, where her research focused on the risk factors for and functions of self-harm behavior. She completed her pre-doctoral internship training, with an emphasis on the treatment of BPD, at McLean Hospital/Harvard Medical School. In July 2003, she was awarded the Psychosocial Fellowship from McLean Hospital/Harvard Medical School. In her role as Clinical and Research Fellow under the mentorship of John G. Gunderson, MD, Dr. Gratz conducted a study examining the efficacy of a new emotion regulation group therapy for the treatment of self-harm among women with BPD and developed a research program to assess the effectiveness of the Borderline Center, McLean Hospital’s specialty clinical services for BPD. During this time, she also served as a primary clinician within McLean Hospital’s DBT program, providing individual and group DBT to clients with BPD and related disorders. In 2004, Dr. Gratz received a grant from the Psychosocial Foundation of McLean Hospital to conduct a preliminary experimental investigation of emotion dysregulation in BPD. She joined the Clinical Psychology Program at the University of Maryland in September 2005.

Selected Publications:

Bornovalova, M. A., Gratz, K. L., Delany-Brumsey, A., Paulson, A., & Lejuez, C. W. (in press). Temperamental and environmental risk factors for borderline personality disorder among inner-city substance users in residential treatment. Journal of Personality Disorders.

Fliege, H., Kocalevent, R., Walter, O. B., Beck, S., Gratz, K. L., Gutierrez, P., & Klapp, B. F. (in press). Three assessment tools for deliberate self-harm and suicide behavior: Evaluation and psychopathological correlates. Journal of Psychosomatic Research.

Gratz, K. L. (in press). Risk for repeated deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. American Journal of Orthopsychiatry.

Gratz, K. L., & Gunderson, J. G. (in press). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy.

Gratz, K. L., Lacroce, D., & Gunderson, J. G. (in press). Measuring changes in BPD-relevant symptoms following short-term treatment at the partial hospital and intensive outpatient levels of care. Journal of Psychiatric Practice.

Tull, M. T., Gratz, K. L., & Lacroce, D. (in press). The role of anxiety sensitivity and lack of emotional approach coping in the presence of depressive symptom severity among non-clinical uncued panickers. Cognitive Behaviour Therapy.

Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.

Gratz, K. L., Tull, M. T., & Wagner, A. W. (2005). Applying DBT mindfulness skills to the treatment of clients with anxiety disorders. In L. Roemer & S. M. Orsillo (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualizations and treatment (pp. 147-161). New York: Springer.

Gunderson, J. G., Gratz, K. L., Neuhaus, E., & Smith, G. (2005). Levels of care in the treatment of personality disorders. In J. M. Oldham, A. E. Skodol, & D. E. Bender (Eds.), Textbook of Personality Disorders (pp. 239-255). Washington, DC: American Psychiatric Publishing.

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54.

Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754-761.

Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.

Gratz, K. L., & Orsillo, S. M. (2003). Scientific expert testimony in CSA cases: Legal, ethical, and scientific considerations. Clinical Psychology: Science and Practice, 10, 358-363.

Gratz, K. L., Conrad, S. D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. American Journal of Orthopsychiatry, 72, 128-140.

Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.

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