1
|
Gillespie C, Murphy M, Kells M, Flynn D. Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of processes and experiences at long-term follow-up. Borderline Personal Disord Emot Dysregul 2022; 9:8. [PMID: 35227318 PMCID: PMC8885141 DOI: 10.1186/s40479-022-00179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative research in the area of DBT is limited, particularly at follow-up. The current study explored the follow-up experiences of individuals who previously received a diagnosis of borderline personality disorder and self-report having benefitted from DBT at the time of treatment. METHODS Individuals who completed 12 months of standard DBT and were a minimum of two years post-completion were recruited. Individual semi-structured interviews were completed with a total of twelve participants. RESULTS A thematic analysis generated three main themes which indicated that participants found DBT had a positive impact on their lives in the years after the programme and enabled further development; gave them control over their lives and the ability to manage setbacks and difficult situations; and contributed to healthier and more meaningful relationships with others. CONCLUSIONS The findings of this study indicated that DBT contributed positively to the participants' lives and helped advance their recovery in the years after the programme. Despite the positive impact of DBT, participants required further support in the years following the intervention. Clinical and research implications of these findings are discussed.
Collapse
Affiliation(s)
- Conall Gillespie
- School of Applied Psychology, University College Cork, Cork, Ireland.
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Daniel Flynn
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| |
Collapse
|
2
|
Schaich A, Braakmann D, Rogg M, Meine C, Ambrosch J, Assmann N, Borgwardt S, Schweiger U, Fassbinder E. How do patients with borderline personality disorder experience Distress Tolerance Skills in the context of dialectical behavioral therapy?-A qualitative study. PLoS One 2021; 16:e0252403. [PMID: 34129606 PMCID: PMC8205175 DOI: 10.1371/journal.pone.0252403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
Distress Tolerance Skills (DTS) are an important component of Dialectical Behavioral Therapy (DBT), a therapy method frequently used for treating patients with Borderline Personality Disorder (BPD). However, little is known about how DTS-training is experienced by individuals with BPD. The aim of this study was to explore BPD patients’ experiences with receiving DTS-training. Qualitative data were collected through semi-structured interviews with 24 individuals (87.5% females) with a primary diagnosis of BPD who received DTS-training in the context of 18 months of DBT treatment. Interview data were analyzed following the procedures of qualitative content analysis. Participants reported various effects of DTS including an immediate reduction of tension. Patients perceived DTS as a tool to cope with difficult interpersonal situations and emergencies and stated that this helped them to feel stable, safe and self-confident. Patients reported difficulties during the initial engagement, the learning process and the application of DTS as well as various facilitating factors. Implications of the findings for further research and for optimizing DTS-training in clinical practice are discussed.
Collapse
Affiliation(s)
- Anja Schaich
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
- * E-mail:
| | - Diana Braakmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Mirco Rogg
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Clara Meine
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Julia Ambrosch
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Nele Assmann
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| |
Collapse
|
3
|
Sheridan Rains L, Echave A, Rees J, Scott HR, Lever Taylor B, Broeckelmann E, Steare T, Barnett P, Cooper C, Jeynes T, Russell J, Oram S, Rowe S, Johnson S. Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis. PLoS One 2021; 16:e0248316. [PMID: 33914750 PMCID: PMC8084224 DOI: 10.1371/journal.pone.0248316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a "personality disorder" diagnosis. Services should be informed by the views of people with these experiences. AIMS To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. METHODS We searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist "personality disorder" services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes. RESULTS Forty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of 'personality disorder' diagnosis. Themes tended to recur across studies from different countries and years. DISCUSSION Recurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist "personality disorder" services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with "personality disorders" throughout the mental health care system.
Collapse
Affiliation(s)
- Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Athena Echave
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jessica Rees
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Billie Lever Taylor
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Eva Broeckelmann
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Thomas Steare
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Phoebe Barnett
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Chris Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tamar Jeynes
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jessica Russell
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sian Oram
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
4
|
Naismith I, Kerr S, Mwale A, Feigenbaum J. A thematic analysis of compassion‐focused imagery for people with personality disorder: Inhibitors, facilitators and clinical recommendations. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Iona Naismith
- Department of Psychology, Universidad de Los Andes, Bogota, Colombia,
| | - Shelley Kerr
- North East London NHS Foundation Trust, London, UK,
| | - Amanda Mwale
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,
| | - Janet Feigenbaum
- North East London NHS Foundation Trust, London, UK,
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,
| |
Collapse
|
5
|
Wall K, Kerr S, Sharp C. Barriers to care for adolescents with borderline personality disorder. Curr Opin Psychol 2020; 37:54-60. [PMID: 32853877 DOI: 10.1016/j.copsyc.2020.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022]
Abstract
Intervention for borderline personality disorder (BPD) in adolescence is crucial as early onset of the disorder predicts more severe course, and intervention 'late' in the course of the disorder is associated with more negative outcomes. In spite of this, access to services is poor. This is because several unique barriers to accessing care exist for adolescents with BPD. In this article we highlight key barriers to care for adolescents with BPD utilizing a conceptual model for understanding health care access that emphasizes the interaction between patient and health care system characteristics. We conclude with proposed recommendations to address these identified barriers.
Collapse
|
6
|
Kraus L, Schmid M, In-Albon T. Anti-Suicide Function of Nonsuicidal Self-Injury in Female Inpatient Adolescents. Front Psychiatry 2020; 11:490. [PMID: 32581870 PMCID: PMC7283589 DOI: 10.3389/fpsyt.2020.00490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There have been numerous studies investigating the relationship between nonsuicidal self-injury (NSSI) and suicidality. On the one side, NSSI is an important risk factor for suicidality, including suicidal thoughts and behaviors. On the other side, it has been suggested that one function of NSSI might be as a coping mechanism that can help individuals in the short term avoid suicide. The present study investigated the relationship between suicidality and NSSI in female inpatient adolescents, focusing on NSSI as an anti-suicide strategy. METHODS Subjects were 56 female adolescents, aged 12-18 years (M = 15.95 years, SD = 1.27), recruited from different inpatient child and adolescent psychiatric units. All participants fulfilled the DSM-5 research criteria for nonsuicidal self-injury disorder (NSSI-D). To assess suicidality, NSSI-D, and current and past diagnoses, a structured clinical interview was conducted. RESULTS NSSI as a short-term coping strategy for avoiding suicide was indicated by one third (32.1%) of the participants. Before participants engaged in NSSI, the anti-suicide function was reported more frequently than reducing interpersonal problems (d = -.59). Getting relief from negative emotions and inducing positive feelings were reported at the same frequency as avoiding suicide before NSSI. Participants engaging in NSSI to avoid suicide and those reporting other functions did not significantly differ regarding other NSSI characteristics, suicidality, or psychopathology. Results indicate that the anti-suicide function significantly predicts the duration of current suicidal ideation (β = .557). CONCLUSION This study provides preliminary support for the idea that NSSI is frequently used by female adolescents with NSSI-D to avoid suicide. Given the high co-occurrence of NSSI and suicidality, our results underline the importance of clinical assessment of suicidality and several NSSI functions, including the anti-suicide function, in adolescents with NSSI.
Collapse
Affiliation(s)
- Laura Kraus
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Germany
| | - Marc Schmid
- Department of Child and Adolescent Psychiatry, University of Basel, Basel, Switzerland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Germany
| |
Collapse
|
7
|
Lamont E, Dickens GL. Mental health services, care provision, and professional support for people diagnosed with borderline personality disorder: systematic review of service-user, family, and carer perspectives. J Ment Health 2019; 30:619-633. [DOI: 10.1080/09638237.2019.1608923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Emma Lamont
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Geoffrey L. Dickens
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
| |
Collapse
|
8
|
Yang KH, Jiang ZX, Chavez F, Wang LH, Yuan CR. Effectiveness of a training program based on maker education for baccalaureate nursing students: A quasi-experimental study. Int J Nurs Sci 2019; 6:24-30. [PMID: 31406865 PMCID: PMC6608676 DOI: 10.1016/j.ijnss.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 10/24/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Objectives Maker education is a dominant force in education reform and is viewed as a revolutionary way to learn. As innovative pedagogy is continuously explored in the field of nursing, the emerging role of maker education must be examined. This research aims to build a nursing bachelor education program based on maker education and to evaluate the effectiveness of this program. Methods Forty volunteer junior students majoring in nursing from a college were the subjects for this quasi-experiment. The training program for nursing students based on maker education was developed and implemented as an additional class for a period of 12 weeks. Before and after the experiment, two measures including the “Williams Creative Scale” and “Current Status Questionnaire of Nursing Students’ Learning” were adopted for investigation, and corresponding statistical methods were used for analysis. The degree of satisfaction with this training program was investigated after the experiment. Results The average scores of creativity, learning interest, cooperative learning skill, scientific research ability, and information attainment of the nursing students after the implementation of maker education all improved. The differences in the above points before and after the experiment were all statistically significant (P < 0.05). Most of the students expressed satisfaction with this training program (72.5% were very satisfied, 15.0% were partially satisfied, and 12.5% were not satisfied). Conclusion Implementing the training program based on maker education enhanced student creativity, learning interest, cooperative learning skill, scientific research ability, and information attainment. Comprehensive nursing talents were also cultivated. Our data suggested the importance of improving this program, adopting the method, and pursuing research in nursing education.
Collapse
Affiliation(s)
- Kai-Han Yang
- College of Medicine (School of Nursing) of Chengdu University, Chengdu, China.,Affiliated Hospital of Chengdu University, Chengdu, China.,Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhi-Xia Jiang
- Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Nursing School of Zunyi Medical University, Zunyi, China
| | - Freida Chavez
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Lian-Hong Wang
- Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | | |
Collapse
|
9
|
Barnicot K, Crawford M. Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators. J Trauma Stress 2018; 31:899-908. [PMID: 30398678 DOI: 10.1002/jts.22340] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly comorbid with personality disorder (PD). We evaluated whether comorbid PTSD has a negative effect on patients' ability to benefit from evidence-based psychological treatments for PD and tested potential mediators of any effect. The effect of PTSD on self-harm and borderline PD symptoms was evaluated in 90 patients with borderline PD who were receiving dialectical behavior therapy or mentalization-based therapy. Self-report and interview measures were administered every 3 months over a 12-month period. Three-quarters of participants met criteria for PTSD. In the 12 months after beginning treatment, participants with PTSD did not engage in self-harm more often or present with more severe borderline PD symptoms. However, a higher level of PTSD symptom severity at baseline was associated with more frequent self-harm during follow-up, incidence rate ratio = 1.03, 95% CI [1.01, 1.06], p = .005. Participants whose PTSD did not improve or worsened were more likely to still self-harm, odds ratio (OR) = 0.91, 95 % CI [0.85, 0.97], p = .004, and report more severe borderline PD symptoms, b = 0.53, 95% CI [0.34, 0.73], p < .001, at the end of 12 months. The negative effects of PTSD symptoms remained significant after adjusting for potential confounders and were partially mediated by high ongoing levels of emotional dysregulation, indirect effect b = 0.32, 95% CI [0.19, 0.50]. These findings identify subgroups at risk of poorer outcomes from evidence-based psychological treatments for PD and support the idea that treating PTSD may improve outcomes.
Collapse
Affiliation(s)
- Kirsten Barnicot
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| | - Mike Crawford
- Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| |
Collapse
|
10
|
Kühne F, Lesser H, Petri F, Weck F. Do mental health patients learn what their cognitive-behaviour therapists think they do? A short report on qualitative interviews comparing perspectives. Int J Qual Stud Health Well-being 2018; 13:1527598. [PMID: 30289028 PMCID: PMC6179057 DOI: 10.1080/17482631.2018.1527598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The acquisition of skills is essential to the conceptualization of cognitive-behavioural therapy. Yet, what experiences are encountered and what skills actually learned during therapy, and whether patients and therapists have concurrent views hereof, remains poorly understood. Method: An explorative pilot study with semi-structured, corresponding interview guides was conducted. Pilot data from our outpatient unit were transcribed and content-analyzed following current guidelines. Results: The responses of 18 participants (patients and their psychotherapists) were assigned to six main categories. Educational and cognitive aspects were mentioned most frequently and consistently by both groups. Having learned Behavioural alternatives attained the second highest agreement between perspectives. Conclusions: Patients and therapists valued CBT as an opportunity to learn new skills, which is an important prerequisite also for the maintenance of therapeutic change. We discuss limitations to generalizability but also theoretical and therapy implications.
Collapse
Affiliation(s)
- Franziska Kühne
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| | - Hannah Lesser
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| | - Franziska Petri
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| | - Florian Weck
- a Department of Psychology, Clinical Psychology and Psychotherapy , University of Potsdam , Potsdam , Germany
| |
Collapse
|
11
|
Little H, Tickle A, das Nair R. Process and impact of dialectical behaviour therapy: A systematic review of perceptions of clients with a diagnosis of borderline personality disorder. Psychol Psychother 2018; 91:278-301. [PMID: 29034599 DOI: 10.1111/papt.12156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 09/04/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To identify, appraise, and synthesize findings from qualitative studies of individuals diagnosed with borderline personality disorder who have experienced dialectical behaviour therapy, to gain further understanding of their perceptions of the process and impact of therapy. METHODS We conducted a comprehensive systematic search of the literature from several online databases, and appraised them using an adapted version of the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize the data. RESULTS Seven studies met the criteria to be included and their quality subsequently appraised. Four main themes were identified through the synthesis process: life before DBT; the relationships that support change; developing self-efficacy; and a shift in perspectives. CONCLUSIONS The findings of the synthesis highlight the importance of a number of key factors in the process of DBT, and the impact that the therapy has both on day-to-day life and on individuals' identity. PRACTITIONER POINTS Existing outcome measures may not capture the complexity and magnitude of impact of DBT on individuals with BPD. Exploring first-hand accounts of individuals undertaking DBT can offer unique insight into the processes of therapy.
Collapse
Affiliation(s)
- Hannah Little
- University of Nottingham and Nottinghamshire Healthcare NHS Trust, UK
| | - Anna Tickle
- University of Nottingham and Nottinghamshire Healthcare NHS Trust, UK
| | | |
Collapse
|
12
|
Probst T, Decker V, Kießling E, Meyer S, Bofinger C, Niklewski G, Mühlberger A, Pieh C. Suicidal Ideation and Skill Use During In-patient Dialectical Behavior Therapy for Borderline Personality Disorder. A Diary Card Study. Front Psychiatry 2018; 9:152. [PMID: 29731724 PMCID: PMC5920639 DOI: 10.3389/fpsyt.2018.00152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/04/2018] [Indexed: 02/04/2023] Open
Abstract
Associations between suicidal ideation and skill use were investigated during in-patient dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Participants were N = 44 patients with BPD undergoing a 5-week in-patient DBT program in a psychiatric clinic. They filled in a diary card each treatment day resulting in 1,334 skill use ratings and 1,364 suicidal ideation ratings. Treatment days were categorized as days with successful skill use (using skills and perceiving them as effective), days with no skill use, days with unsuccessful skill use (using skills but perceiving them as ineffective). Multilevel models were performed to account for the nested data structure. The results showed that suicidal ideation improved more for patients who applied skills successfully more often during treatment (p < 0.05). Moreover, suicidal ideation was lower on treatment days with successful skill use compared to treatment days with no skill use and compared to treatment days with unsuccessful skill use (p < 0.05). When treatment days with no skill use were compared to treatment days with unsuccessful skill use, suicidal ideation was higher on treatment days with unsuccessful skill use (p < 0.05). To conclude, using skills successfully on as many treatment days as possible is associated with lower suicidal ideation.
Collapse
Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Verena Decker
- Institute for Psychology, Regensburg University, Regensburg, Germany
| | - Eva Kießling
- Institute for Psychology, Regensburg University, Regensburg, Germany
| | - Sascha Meyer
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Christine Bofinger
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Günter Niklewski
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | | | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| |
Collapse
|
13
|
Naismith I, Mwale A, Feigenbaum J. Inhibitors and facilitators of compassion-focused imagery in personality disorder. Clin Psychol Psychother 2017; 25:283-291. [PMID: 29251381 DOI: 10.1002/cpp.2161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/25/2017] [Accepted: 10/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Compassion-focused therapy (CFT) has potential to benefit clients with a personality disorder (PD), given the inflated levels of shame and self-criticism in this population. However, clinical observation indicates that clients with PD may find techniques from this approach challenging. AIMS The aim of this study is to trial one aspect of CFT, compassion-focused imagery (CFI), with this population, and identify factors that predict clients' ability to generate CFI and experience self-compassion during the task, including type of CFI exercise and, second, to establish whether CFI outcomes increase with practice. METHOD In Study 1, 53 participants with a diagnosis of PD completed measures of self-compassion, self-reassurance, shame, self-criticism, fear of self-compassion, affect, anxious and avoidant attachment, and mental imagery abilities. Participants were assigned to trial CFI from memory (n = 25) or from imagination (n = 28), then rated their image's vividness, its compassionate traits, and ease of experiencing compassion. A negative mood manipulation was carried out, and CFI tasks and outcome measures were repeated. For Study 2, self-compassion and self-criticism were measured before and after 1 week of daily CFI practice. RESULTS Study 1 found that negative mood and low mental imagery ability are significant inhibitors to generating compassionate images and affect. The 2 CFI exercises were equally effective. Study 2 suffered from high attrition, but regular practice was associated with significant improvement in self-compassion (though not self-criticism). CONCLUSIONS CFI appears to be effective in improving self-compassion for some clients. However, it is less effective in the presence of negative affect. Clients with low mental imagery ability may benefit more from alternative CFT techniques.
Collapse
Affiliation(s)
| | - Amanda Mwale
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
14
|
Ibraheim M, Kalpakci A, Sharp C. The specificity of emotion dysregulation in adolescents with borderline personality disorder: comparison with psychiatric and healthy controls. Borderline Personal Disord Emot Dysregul 2017; 4:1. [PMID: 28078089 PMCID: PMC5223469 DOI: 10.1186/s40479-017-0052-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has supported the notion that emotion dysregulation is a core feature of BPD. However, given that this feature is typical of healthy adolescents as well as adolescents with other psychiatric disorders, the specificity of emotion dysregulation to BPD in this age group has not yet been determined. The overall aim of this study was to examine emotion dysregulation in adolescent inpatients with BPD compared with non-BPD inpatient adolescents and healthy non-clinical adolescents, taking into account both global emotion dysregulation deficits and more specific impairments. METHOD The sample included 185 adolescent inpatients with BPD (M = 15.23, SD = 1.52), 367 non-BPD psychiatric inpatient adolescents (M = 15.37, SD = 1.40), and 146 healthy adolescents (M = 15.23, SD = 1.22), all of whom were between the ages of 12 and 17. Borderline personality features were assessed, along with emotion dysregulation and psychiatric severity. RESULTS After controlling for age, gender, and psychiatric severity, results revealed that adolescents with BPD had higher overall emotional dysregulation compared with non-BPD psychiatric controls and healthy controls. These differences were apparent in only two domains of emotion dysregulation including limited access to emotion regulation strategies perceived as effective and impulse control difficulties when experiencing negative emotions. CONCLUSIONS Findings suggest BPD-specific elevations on emotion dysregulation generally, and subscales related to behavioral regulation specifically.
Collapse
Affiliation(s)
- Marina Ibraheim
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| | - Allison Kalpakci
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| | - Carla Sharp
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204 USA
| |
Collapse
|
15
|
Barnicot K, Gonzalez R, McCabe R, Priebe S. Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder. J Behav Ther Exp Psychiatry 2016; 52:147-156. [PMID: 27132175 DOI: 10.1016/j.jbtep.2016.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Dialectical behaviour therapy (DBT) trains participants to use behavioural skills for managing their emotions. The study aimed to evaluate whether skills use is associated with positive treatment outcomes independently of treatment processes that are common across different therapeutic models. METHOD Use of the DBT skills and three common treatment processes (therapeutic alliance, treatment credibility and self-efficacy) were assessed every 2 months for a year in 70 individuals with borderline personality disorder receiving DBT. Mixed-multilevel modelling was used to determine the association of these factors with frequency of self-harm and with treatment dropout. RESULTS Participants who used the skills less often at any timepoint were more likely to drop out of DBT in the subsequent two months, independently of their self-efficacy, therapeutic alliance or perceived treatment credibility. More frequent use of the DBT skills and higher self-efficacy were each independently associated with less frequent concurrent self-harm. Treatment credibility and the alliance were not independently associated with self-harm or treatment dropout. LIMITATIONS The skills use measure could not be applied to a control group who did not receive DBT. The sample size was insufficient for structural equation modelling. CONCLUSION Practising the DBT skills and building an increased sense of self-efficacy may be important and partially independent treatment processes in dialectical behaviour therapy. However, the direction of the association between these variables and self-harm requires further evaluation.
Collapse
Affiliation(s)
- Kirsten Barnicot
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| | - Rafael Gonzalez
- Centre for Mental Health, Imperial College London, Commonwealth Building, Du Cane Road, London, W12 0NN, United Kingdom.
| | - Rosemarie McCabe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, Cherry Tree Way, Glen Road, London, E13 8SP, United Kingdom.
| |
Collapse
|