Center for Emotion and Behavior Integration

photo of Psychiatry and Behavioral Sciences Building
Center for Emotion and Behavior Integration
Psychiatry and Behavioral Sciences Building
Map & directions
713 Harrison Street, Syracuse, NY 13210
Phone: 315 464-3130
Fax: 315 464-3141

The Center for Emotion and Behavior Integration provides intensive, time-limited outpatient treatment for adolescents and young adults (17-45 years of age) suffering from complex behavioral problems. The Center encompasses a variety of treatment approaches based upon the most up-to-date neurocognitive and psychosocial understanding of the causes for these problems. Specific services that are available include comprehensive prescreening testing, diagnostic evaluation, individual psychotherapies, group therapies, family consultation, and medication management. The specific treatment package is tailored to the needs of the individual patient.

Providers

Robert J Gregory, MD

Robert J Gregory, MD
Appointed 05/01/93
336 Psychiatry and Behavioral Sciences Building
713 Harrison Street
Syracuse, NY 13210

315 464-3105

Current Appointments

Hospital Campus

  • Downtown

Research Programs and Affiliations

  • Psychiatry and Behavioral Sciences

Clinic/Unit

Education & Fellowships

  • Residency: Harvard Medical School, 1990, Psychiatry
  • Internship: University of Rochester Medical Center, 1987, Internal Medicine
  • MD: SUNY Buffalo, 1986

Clinical Interests

  • Borderline personality disorder, addictions, psychotherapy

Education Interests

  • personality disorders, psychotherapy, addictions, biopsychosocial integration

Research Interests

  • Borderline personality disorder, addictions, neuroscience, psychotherapy

Specialties & Certification

  • Psychiatry

Diseases & Conditions Treated

  • Borderline Personality Disorder

Treats

  • Adults

Treatments/Services

  • Dynamic Deconstructive Psychotherapy
  • Psychodynamic Psychotherapy
  • Psychopharmacology

Associations/Memberships

  • American Psychiatric Association (APA)
  • Onondaga County Medical Society
  • Medical Society of The State of New York

Current Hospital Privileges

  • Upstate University Hospital

HealthLinkOnAir Radio Interview

7/1/12 Psychotherapy for treatment resistant borderline personality disorder

1/2/11 Interesting new studies about narcissism

Research Abstract

Thematic Stages of Recovery in the Treatment of Borderline Personality Disorder

Employing a case illustration and object relations theory, the author postulates that persons with borderline personality disorder have specific thematic questions that they are trying to resolve at sequential stages of their recovery. Each of the four thematic stages entails characteristic patient-therapist interactions, underlying conflicts, associated behaviors, and unique challenges and pitfalls that must be overcome in order to avoid traumatic re-enactment and move forward in recovery.

Borderline Attributions

The author explores how persons with borderline personality disorder attempt to generate meaning, eliminate ambiguity, and maintain idealizations by assigning polarized, binary attributions to their experiences.The author proposes that these binary attributions interact to form multiple, discrete self-structures or states of being. Each state is characterized by stereotyped expectations for self and other and self-perpetuating patterns of relatedness.The author delineates four common states, labeled as helpless victim, guilty perpetrator, angry victim, and demigod perpetrator, and suggests treatment strategies to deconstruct each state and to facilitate the development of an integrated and differentiated self.

Psychotherapy for Treatment Resistant Borderline Personality Disorder

A manual-based treatment, labeled dynamic deconstructive psychotherapy, was developed for those patients with borderline personality disorder who are most difficult to engage in therapy, such as those having co-occurring substance use disorders.  This treatment model is based on the hypothesis that borderline pathology and related behaviors reflect impairment in specific neurocognitive functions that form the basis for a coherent and differentiated self.  DDP aims to activate and remediate neurocognitive self-capacities by facilitating elaboration of affect-laden interpersonal experiences and integration of attributions, as well as providing novel experiences in the patient-therapist relationship that promote self-other differentiation.  Treatment involves weekly individual sessions for a predetermined period of time and follows sequential stages.

Dynamic Deconstructive Psychotherapy for Borderline Personality Disorder and Alcohol Use Disorders

A randomized controlled trial was conducted to determine whether dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder.  Thirty participants were assessed every 3 months during a year of treatment with either DDP or optimized community care.  By 12 months, DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67-73%.  Almost all participants who received at least 6 months of DDP demonstrated clinically meaningful change.  Although community participants received higher average treatment intensity, they showed only limited change during the same period.  After an additional 18 months of naturalistic follow-up following termination of treatment, DDP participants demonstrated sustained treatment effects over a broad range of outcomes and achieved significantly greater improvement in core BPD symptoms, depression, parasuicide, and recreational drug use than participants who had received optimized community care. These results suggest that DDP is a cost effective treatment that can lead to broad and sustained improvement for the dually diagnosed subgroup. 

Relationship between adherence and outcome in dynamic deconstructive psychotherapy

Independent raters coded video-recorded sessions on adherence to DDP techniques, as well as therapeutic alliance and standard cognitive behavioral and psychodynamic techniques.  The adherence instrument demonstrated excellent inter-rater and test-retest reliability.  Adherence to DDP techniques was positively related to improvement in BPD symptoms (rho = .64) and most secondary outcomes.

Selected References

Gregory RJ: Thematic stages of recovery in the treatment of borderline personality disorder. American Journal of Psychotherapy. 58:335-348, 2004.

Gregory RJ: The deconstructive experience. American Journal of Psychotherapy. 59:295-305, 2005.

Gregory RJ: Clinical challenges in the management of patients with co-occurring borderline personality and substance use disorders. Psychiatric Times. 23:16-18, 2006.

Gregory RJ: Borderline attributions. American Journal of Psychotherapy. 61:131-147, 2007.

Gregory RJ, Remen AL: A manual-based psychodynamic therapy for treatment-resistant borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training 45:15-27, 2008.

Gregory RJ, Chlebowsky S, Kang D, Remen AL, Soderberg MG, Stepkovitch J: A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy: Theory, Research, Practice, Training.   45:28-41, 2008.

Goldman GA, Gregory RJ: Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy. Psychotherapy: Theory, Research, Practice, Training.  46:480-485, 2009.

Gregory RJ, Delucia-Deranja E, Mogle JA: Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: 30-month follow-up. Journal of Nervous and Mental Disease.  198:292-298, 2010.

Clinical Profile Shortcut: http://www.upstate.edu/findadoc/gregoryr
Faculty Profile Shortcut: http://www.upstate.edu/faculty/gregoryr

What are complex behavioral problems?

Complex behavioral problems are maladaptive sets of behaviors that are used to cope with negative emotions and interpersonal stresses. Patients who suffer from self-harm, eating disorders, addictions, recurrent suicide attempts, and/or borderline personality disorder may be eligible for treatment at the Center. Because of the affected brain regions involved in these conditions, they often are accompanied by anxiety, depression, mood instability, and poor interpersonal functioning.

What causes complex behavioral problems?

Recent neuroscience research is pointing the way toward a better understanding of complex behavioral problems. Neuroimaging studies suggest that individuals who suffer from these behaviors react to emotional stress in a different way from most other people. There is a relative deactivation of certain prefrontal regions of the brain, which are responsible for helping us to be aware of our emotional experiences and adaptively manage them. On the other hand, there is relative hyper-activation of certain other brain regions (amygdala and ventral striatum), which can account for much of the mood reactivity, anxiety, and distress that patients with complex behavior problems suffer from. The ventral striatum triggers pleasure seeking behaviors (such as drug addiction, bingeing, compulsive gambling), as well as attachment seeking behaviors, which can contribute to rejection sensitivity.

If the brain is functioning abnormally, is there anything that can be done?

YES! Multiple neuroimaging studies suggest that specific kinds of psychotherapy and medication interventions can remediate the neural networks in the brain to normalize activity of the various regions. This is not an easy process, but with the right combination of treatment and with hard work and determination on the part of the patient, success can be achieved!

What treatments are offered at the Center?

  • Outpatient Medical Detoxification. This program is run by our addiction specialist, Dr. Brian Johnson, a Harvard trained psychiatrist. It is only the second outpatient detoxification program in NYS and promotes access and continuity of care.
  • Dialectical Behavior Therapy. This program is directed by Jean Shook, RN, PNP, a practitioner with extensive DBT training and experience. DBT is an evidence-based treatment that has been shown to reduce maladaptive behaviors by teaching alternative skills for managing negative emotions and interpersonal stresses.
  • Dynamic Deconstructive Psychotherapy. The Center is the only location in NYS where this treatment is offered. DDP is an evidence-based treatment for complex behavior problems that has been shown to improve symptoms and restore functioning in treatment-resistant patients. The DDP program is run by Drs. Evan Deranja, Robert Gregory, and Georgian Mustata.
  • Eating Disorders Program. This program is run by Kathleen Deters Hayes, LCSW-R, a Menninger-trained therapist. Initial focus of the program is on medical stability. Through both individual and group psychotherapy, patients will learn how to express emotions, develop a solid "sense of self", manage trauma, and develop healthy relationships.
  • Family Therapy. This program is run by Dr. Rebecca King, a psychiatrist specializing in family therapy. She employs Carl Whitaker's pioneering approach to family systems and is available for consultation or on-going treatment.
  • Group Therapy. Two kinds of group therapies are offered at the Center: Dialectical Behavior Therapy and Systems Centered Therapy. The former focuses on learning new coping skills and the latter focuses in improving interpersonal relationships. Both treatments often complement individual therapies for complex behavior problems.
  • Medication Management. Although medications tend to have more modest effects for complex behavioral problems, they can be an important component of the overall treatment plan.