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Moltu C, Kverme B, Veseth M, Natvik E. How people diagnosed with borderline personality disorder experience relationships to oneself and to others. A qualitative in-depth study. Int J Qual Stud Health Well-being 2023; 18:2152220. [DOI: 10.1080/17482631.2022.2152220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring sciences, Western Norway University of Applied Science, Førde, Norway
| | - Britt Kverme
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Borgestadklinikken, Blue Cross Resource Centre for Substance Dependence Problems, Skien, Norway
| | - Marius Veseth
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Eli Natvik
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring sciences, Western Norway University of Applied Science, Førde, Norway
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Dhar A, Hay P, Meade T. Social and Occupational Functioning in Individuals With BPD: A Systematic Review. J Pers Disord 2023; 37:691-723. [PMID: 38038659 DOI: 10.1521/pedi.2023.37.6.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
This systematic review aimed to explore social and occupational functioning levels in individuals with BPD and whether this varies according to symptomatic status, age, or gender. A multi-database search was conducted for articles, and of the 1164 records identified, 19 were included in this review. Of the 15 studies reporting on social functioning, 13 indicated significant levels of impairment, and of the 14 studies reporting on global functioning, all indicated significant impairment across both clinical and in-remission populations. Occupational functioning was primarily assessed as either a part of global functioning or by subscales within social functioning, highlighting a lack of use of dedicated measures for its assessment. This systematic review found that individuals with BPD experience a range of significant impairments in functioning persisting across the lifespan. Further studies are warranted to explore levels of functional impairment across all functional domains and factors associated with continual functional impairment in this population.
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Affiliation(s)
- Abhijatya Dhar
- School of Psychology, Western Sydney University, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
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Choi-Kain LW, Masland SR, Finch EF. Corrective Experiences to Enhance Trust: Clinical Wisdom From Good (Enough) Psychiatric Management. J Pers Disord 2023; 37:559-579. [PMID: 37903019 DOI: 10.1521/pedi.2023.37.5.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.
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Affiliation(s)
- Lois W Choi-Kain
- McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston Massachusetts
| | - Sara R Masland
- Psychology Department, Pomona College, Claremont, California
| | - Ellen F Finch
- Psychology Department, Graduate School of Arts and Sciences, Harvard University, Cambridge, Massachusetts
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Shaw A. Women in mid-life and older age in recovery from illicit drug use: connecting and belonging. Front Psychiatry 2023; 14:1221500. [PMID: 37636828 PMCID: PMC10450501 DOI: 10.3389/fpsyt.2023.1221500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Establishing and maintaining healthy social connections and relationships are important in encouraging a sense of belonging that can help mid-life and older aged women in recovery from illicit drug use. This paper contributes to an under-researched area of substance use recovery among women in mid-life and older age by asking what influence social relationships have on their sense of self as they age into recovery from illicit drugs. Methods In-depth qualitative interviews were undertaken with 19 women in the United Kingdom who self-identified as 'in recovery' from illicit drug use. The interviews were transcribed verbatim and analyzed using Braun and Clarke's thematic analysis techniques. The study received ethical approval from the University of Glasgow. Results As their drug use progressed, the women experienced feelings of estrangement and separation from others. Entering and maintaining a healthy recovery from drug use required the women to break their connections to people considered disruptive or challenging. Creating and setting boundaries enabled some of the women to gain a sense of control over their relationships and recovery. Positive reinforcement from others was pivotal to the process of the women's self-acceptance, contributing to better self-concepts that helped them maintain their recovery. Discussion This investigation into substance use recovery among women in mid-life and older age offers new insights into the relationship challenges they face. It offers suggestions for further research that could support the development of family support programs for mid-life and older age women in active drug use or recovery.
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Affiliation(s)
- April Shaw
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Science, University of Stirling, Stirling, United Kingdom
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Marrero RJ, Bello M, Morales-Marrero D, Fumero A. Emotion Regulation Difficulties, Family Functioning, and Well-Being Involved in Non-Suicidal Self-Injury and Suicidal Risk in Adolescents and Young People with Borderline Personality Traits. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1057. [PMID: 37371288 DOI: 10.3390/children10061057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Individuals with a borderline personality disorder (BPD) or BPD traits usually have a lifetime history of harmful behaviors. Emotion regulation difficulties are a risk factor for suicide, whereas adequate family functioning and well-being play an important protective role. This study aims to determine the role of emotion regulation difficulties, well-being, and family functioning in the suicide risk and non-suicidal self-injury (NSSI) in adolescents and young people with BPD traits. From a sample of 285 young people, 103 (36.1%) had BPD traits (mean age = 16.82, SD = 2.71), and 68.93% were females. The results showed significant differences in personal and family variables according to the type of harmful behavior. Suicide attempts (SA) were mainly predicted by difficulties in impulse control, whereas NSSI was predicted by low family satisfaction. Programs designed to prevent SA and NSSI should consider individual differences, as well as the type of harmful behaviors exhibited.
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Affiliation(s)
- Rosario J Marrero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología y Logopedia, Universidad de La Laguna, 38200 La Laguna, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Spain
| | - Macarena Bello
- Instituto Andrés Bello, 38007 Santa Cruz de Tenerife, Spain
| | - Daida Morales-Marrero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología y Logopedia, Universidad de La Laguna, 38200 La Laguna, Spain
| | - Ascensión Fumero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología y Logopedia, Universidad de La Laguna, 38200 La Laguna, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Spain
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Woodbridge J, Townsend ML, Reis SL, Grenyer BFS. Patient perspectives on non-response to psychotherapy for borderline personality disorder: a qualitative study. Borderline Personal Disord Emot Dysregul 2023; 10:13. [PMID: 37072881 PMCID: PMC10114439 DOI: 10.1186/s40479-023-00219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Despite increasing evidence for the effectiveness of psychotherapy for Borderline Personality Disorder (BPD), estimates show that approximately half of those in treatment do not clinically improve or reach reliable change criteria. There are limited qualitative descriptions of treatment factors associated with non-response from the perspectives of those struggling to improve. METHOD Eighteen people (72.2% female, mean age 29.4 (SD = 8)) with experience of receiving psychotherapeutic treatment for BPD were interviewed to obtain their perspectives on hindering factors in treatment and what may be helpful to reduce non-response. The data in this qualitative study was analysed thematically. RESULTS Four domains were created from the insights patients shared on non-response and what may be needed to mitigate it. The focus of Domain 1 was that therapy cannot be effective until two factors are in place. First, the patient needs sufficient safety and stability in their environment in order to face the challenges of therapy. Second, they need to be able to access therapy. Domain 2 described factors the patients themselves contribute. The themes in this domain were described as phases that need to be progressed through before therapy can be effective. These phases were ceasing denial that help is warranted and deserved, taking responsibility for behaviours that contribute to unwellness, and committing to the hard work that is required for change. Domain 3 described how the lack of a safe alliance and ruptures in the safety of the relationship with the therapist can contribute to non-response. Domain 4 was comprised of factors that patients identified as supportive of moving through the barriers to response. The first theme in this domain was prioritising the safety of the therapy relationship. The second theme was giving a clear diagnosis and taking a collaborative approach in sessions. The final theme described the importance of focusing on practical goals with the patient to create tangible life changes. CONCLUSION This study found that non-response is complex and multifaceted. First, it is clear that systems need to be in place to support access to adequate care and foster life stability. Second, considerable effort may be needed at the engagement phase of therapy to clarify expectations. Third, attention to specific interpersonal challenges between patients and therapists is an important focus. Finally, structured work to improve relationships and vocational outcomes is indicated.
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Affiliation(s)
- Jane Woodbridge
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Michelle L Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Samantha L Reis
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Brin F S Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia.
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Pol SM, Schug F, Chakhssi F, Westerhof GJ. Life stories of patients with personality disorders before and after treatment: Change and stability in agency and communion. Front Psychiatry 2023; 14:1134796. [PMID: 37009106 PMCID: PMC10060533 DOI: 10.3389/fpsyt.2023.1134796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Studying written life stories of patients with personality disorders (PDs) may enhance knowledge of how they understand themselves, others and the world around them. Comparing the construction of their life stories before psychotherapy to their reconstruction after psychotherapy may provide insight in therapeutic changes in the understandings of their lives. Methods As few studies addressed this topic, the current study explored changes in agency (i.e., perceived ability to affect change in life), and communion (i.e,, perceived connectedness to other persons) in written life stories of 34 patients with various PDs, before and after intensive psychotherapy treatment. Results Life stories showed a positive increase in agency from pre- to posttreatment, in particular regarding internal agency, societal success, and occupational success. No significant changes were observed for communion as a whole. However, the perceived number and quality of close relationships revealed a significant positive increase. Discussion The increased agency in the reconstruction of patients' life story after psychotherapy suggests that patients improved their perceived ability to affect change in their own lives. This can be seen as an important step in the treatment of PDs towards further recovery.
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Affiliation(s)
- Silvia M. Pol
- GGNet Scelta, Apeldoorn, Netherlands
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | | | - Farid Chakhssi
- GGNet Scelta, Apeldoorn, Netherlands
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | - Gerben J. Westerhof
- GGNet Scelta, Apeldoorn, Netherlands
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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Friesen L, Gaine G, Klaver E, Burback L, Agyapong V. Key stakeholders’ experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care. PLoS One 2022; 17:e0274197. [PMID: 36137103 PMCID: PMC9499299 DOI: 10.1371/journal.pone.0274197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background The diagnosis of borderline personality disorder (BPD) consists of extreme emotional dysregulation and long-term disability when left untreated. It is associated with ineffective use of health care systems and mismanaged care in emergency departments, which can result in a revolving door phenomenon of urgent system usage, poor treatment outcomes, or patients falling out of care entirely–all of which primarily affect patients with BPD as well as their caregivers and clinicians. This crisis must be addressed with a comprehensive understanding of key stakeholder perspectives on the challenges of the system and potential solutions. Objective This study explored the perspectives of three key stakeholder groups (i.e., patients, clinicians, and caregivers) in relation to their experiences with and future expectations of the care system for those affected by BPD. Methods Four patients with BPD, three generalist clinicians with experience treating BPD, and three caregivers of individuals with BPD participated in individual semi-structured interviews. Participants were asked about their experiences with the current healthcare system and their suggestions for improvement. Responses were analyzed using interpretative phenomenological analysis. Findings In-depth analysis of the qualitative data revealed twelve shared themes and three themes that were unique to each key stakeholder group. These themes are discussed and used to inform recommendations for promising practices, policies, and training in this area. Conclusion Findings support the importance of a comprehensive mental health system approach for improving the accessibility, effectiveness, and acceptability of the management and treatment of BPD.
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Affiliation(s)
- Laura Friesen
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- * E-mail:
| | - Graham Gaine
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen Klaver
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa Burback
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent Agyapong
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Fagan S, Hodge S, Morris C. Experiences of Compassion in Adults With a Diagnosis of Borderline Personality Disorder: An Interpretative Phenomenological Analysis. Psychol Rep 2022; 125:1326-1347. [PMID: 33730923 PMCID: PMC9136373 DOI: 10.1177/00332941211000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study explored experiences of compassion in adults with a diagnosis of Borderline Personality Disorder (BPD) to further the development of the construct of compassion in relation to BPD. Interpretative Phenomenological Analysis was used to develop themes from the narratives of six adults with a diagnosis of BPD. Five themes emerged: Emotional Connection to Suffering, Empathic Understanding, Prioritisation of Needs, A Model of Genuine Compassion and Developing Acceptance and Worth. Participants described the role of compassion in their difficulties, including the adverse impact of experiences of incompassion upon their sense of self. The themes were integrated into a model that highlighted a process of recovery through therapeutic encounters with others in which genuine compassion was modelled. In addition, barriers to compassion and factors facilitating the development of compassion emerged from the analysis and have implications for clinical practice.
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Affiliation(s)
- Stephanie Fagan
- Primary/Intermediate Mental Health Team, 1756Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Suzanne Hodge
- Division of Health Research, 4396Lancaster University, Lancaster, UK
| | - Charlotte Morris
- Recovery Team, North West Boroughs Healthcare NHS Trust, Warrington, UK
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Schmidt P. Affective Instability and Emotion Dysregulation as a Social Impairment. Front Psychol 2022; 13:666016. [PMID: 35496195 PMCID: PMC9051371 DOI: 10.3389/fpsyg.2022.666016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Borderline personality disorder is a complex psychopathological phenomenon. It is usually thought to consist in a vast instability of different aspects that are central to our experience of the world, and to manifest as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” [American Psychiatric Association (APA), 2013, p. 663]. Typically, of the instability triad—instability in (1) self, (2) affect and emotion, and (3) interpersonal relationships—only the first two are described, examined, and conceptualized from an experiential point of view. In this context, disorders of self have often motivated analyses of self-experience and the sense of self, affective disorders have been frequently considered in the light of emotional experience and its phenomenological structure. Patterns in the phenomenology of social experience have found comparatively little traction when it comes to the conceptualization of the interpersonal disturbances in borderline. In this paper, I argue that interpersonal instability in borderline consists in much more than fragile and shifting relationships but, most importantly, also involves certain styles in experiencing others. These styles, I suggest, may play an explanatory role for the borderline-typical patterns of interpersonal turmoil and so deserve more attention. To better describe and understand these styles, I explore the phenomenological structure of borderline affective instability and discuss the implications it might have for how a person experiences and relates to other people. Considering core aspects of borderline affective instability, such as alexithymia, emotional contagion, emotion dysregulation, and chronic emptiness, I propose borderline can be interpreted as a disturbance of interaffective exchange, which gives rise to certain ways of experiencing others that imply a social impairment.
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Affiliation(s)
- Philipp Schmidt
- Department of Philosophy, Technical University Darmstadt, Darmstadt, Germany
- Department of Philosophy, Julius Maximilian University of Würzburg, Würzburg, Germany
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
- *Correspondence: Philipp Schmidt,
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Kvarstein EH, Zahl KE, Stänicke LI, Pettersen MS, Baltzersen ÅL, Johansen MS, Eikenaes IUM, Arnevik EA, Hummelen B, Wilberg T, Pedersen G. Vulnerability of personality disorder during the Covid-19 crises - a multicenter survey of treatment experiences among patients referred to treatment. Nord J Psychiatry 2022; 76:52-63. [PMID: 34126854 DOI: 10.1080/08039488.2021.1934110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementation of treatment modifications was required for patients typically characterized by insecure attachment and vulnerability to separation. AIM To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD. DESIGN A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs. RESULTS The response-rate was 12% (N = 133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly telephone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations. CONCLUSION The survey confirms a radical modification from comprehensive group-based PD programs to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable concern about treatment progress.
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Affiliation(s)
- Elfrida Hartveit Kvarstein
- Department for National and Regional Functions, Division of Mental Health and Addiction, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell-Einar Zahl
- Group Therapy Section, Follo District Psychiatric Centre, Akershus University Hospital, Nordbyhagen, Norway
| | - Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway.,Nic Waals Institute, Lovisenberg Deacon Hospital, Oslo, Norway
| | - Mona Skjeklesaether Pettersen
- Department of Substance Abuse, Clinic for Mental Health and Addiction Treatment, University Hospital of North Norway, Tromsø, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Åse-Line Baltzersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Merete Selsbakk Johansen
- Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Ingeborg Ulltveit-Moe Eikenaes
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Espen Ajo Arnevik
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
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12
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Watts R, Kettner H, Geerts D, Gandy S, Kartner L, Mertens L, Timmermann C, Nour MM, Kaelen M, Nutt D, Carhart-Harris R, Roseman L. The Watts Connectedness Scale: a new scale for measuring a sense of connectedness to self, others, and world. Psychopharmacology (Berl) 2022; 239:3461-3483. [PMID: 35939083 PMCID: PMC9358368 DOI: 10.1007/s00213-022-06187-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
RATIONALE A general feeling of disconnection has been associated with mental and emotional suffering. Improvements to a sense of connectedness to self, others and the wider world have been reported by participants in clinical trials of psychedelic therapy. Such accounts have led us to a definition of the psychological construct of 'connectedness' as 'a state of feeling connected to self, others and the wider world'. Existing tools for measuring connectedness have focused on particular aspects of connectedness, such as 'social connectedness' or 'nature connectedness', which we hypothesise to be different expressions of a common factor of connectedness. Here, we sought to develop a new scale to measure connectedness as a construct with these multiple domains. We hypothesised that (1) our scale would measure three separable subscale factors pertaining to a felt connection to 'self', 'others' and 'world' and (2) improvements in total and subscale WCS scores would correlate with improved mental health outcomes post psychedelic use. OBJECTIVES To validate and test the 'Watts Connectedness Scale' (WCS). METHODS Psychometric validation of the WCS was carried out using data from three independent studies. Firstly, we pooled data from two prospective observational online survey studies. The WCS was completed before and after a planned psychedelic experience. The total sample of completers from the online surveys was N = 1226. Exploratory and confirmatory factor analysis were performed, and construct and criterion validity were tested. A third dataset was derived from a double-blind randomised controlled trial (RCT) comparing psilocybin-assisted therapy (n = 27) with 6 weeks of daily escitalopram (n = 25) for major depressive disorder (MDD), where the WCS was completed at baseline and at a 6-week primary endpoint. RESULTS As hypothesised, factor analysis of all WCS items revealed three main factors with good internal consistency. WCS showed good construct validity. Significant post-psychedelic increases were observed for total connectedness scores (η2 = 0.339, p < 0.0001), as well as on each of its subscales (p < 0.0001). Acute measures of 'mystical experience', 'emotional breakthrough', and 'communitas' correlated positively with post-psychedelic changes in connectedness (r = 0.42, r = 0.38, r = 0.42, respectively, p < 0.0001). In the RCT, psilocybin therapy was associated with greater increases in WCS scores compared with the escitalopram arm (ηp2 = 0.133, p = 0.009). CONCLUSIONS The WCS is a new 3-dimensional index of felt connectedness that may sensitively measure therapeutically relevant psychological changes post-psychedelic use. We believe that the operational definition of connectedness captured by the WCS may have broad relevance in mental health research.
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Affiliation(s)
- Rosalind Watts
- Centre for Psychedelic Research, Imperial College London, London, UK. .,Acer Integration, London, UK. .,Synthesis Institute, Amsterdam, Netherlands.
| | - Hannes Kettner
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Dana Geerts
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK ,grid.5012.60000 0001 0481 6099Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sam Gandy
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Laura Kartner
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Lea Mertens
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Christopher Timmermann
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Matthew M. Nour
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Mendel Kaelen
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - David Nutt
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK
| | - Robin Carhart-Harris
- grid.7445.20000 0001 2113 8111Centre for Psychedelic Research, Imperial College London, London, UK ,grid.266102.10000 0001 2297 6811Psychedelics Division, Department of Neurology, University of California San Francisco, Neuroscape, USA
| | - Leor Roseman
- Centre for Psychedelic Research, Imperial College London, London, UK.
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13
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The relationship between emotion dysregulation and suicide ideation and behaviour: A systematic review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Vera San Juan N, Gronholm PC, Heslin M, Lawrence V, Bain M, Okuma A, Evans-Lacko S. Recovery From Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives. Front Psychiatry 2021; 12:712026. [PMID: 34539464 PMCID: PMC8440827 DOI: 10.3389/fpsyt.2021.712026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention. Systematic Review Registration: The review protocol was registered on PROSPERO (CRD42017076450); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=76450.
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Affiliation(s)
- Norha Vera San Juan
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Petra C Gronholm
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Margaret Heslin
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Vanessa Lawrence
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Matthew Bain
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Ayako Okuma
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
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15
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Esposito G, Perla V, Passeggia R, Fertuck E, Mergenthaler E. Reflective functioning and personal recovery process of users with borderline personality disorder on Instagram: an explorative study using computerized and thematic analysis. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:463. [PMID: 33585291 PMCID: PMC7875072 DOI: 10.4081/ripppo.2020.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Abstract
Although recent literature has stated that mentalizing (or reflective functioning; RF) promoted the clinical recovery (symptomatic remission; CR) of individuals with borderline personality disorder (BPD), to our knowledge, there have been no studies that analyzed the relationship between RF and a process more complex than CR, namely personal recovery (PR) - a deep and unique process of change in one's attitudes, values, feelings, goals and/or roles. Furthermore, while there have been a few studies concerning PR of BPD individuals, but to date none analyzed PR of BPD individuals through online narratives shared on social media platforms. This study investigates the relationship between RF and PR of 14 Instagram users with a selfreported diagnosis of BPD. Two groups of users were distinguished on the basis of hashtags, #bpd and #bpdrecovery. Seventy randomized text posts (5 from each user) were extracted from users' profiles: 35 from the #bpd group and 35 from #bpdrecovery. Two methods of analysis were applied: i) a thematic analysis, by using the theoretical framework CHIME, which identifies five dimensions of PR; and ii) a stylistic analysis of RF utilizing computerized reflective functioning (CRF), which identifies RF lexical markers. Results indicate that the #bpdrecovery group presented more dimensions of PR, and that its posts showed a significantly higher RF than the #bpd group. These findings suggest that RF could be involved in the PR of BPD individuals, thus mentalization-based treatment could be effective in supporting PR processes and enhancing the impaired RF in BPD users even in the online context.
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Affiliation(s)
| | - Viviana Perla
- Department of Humanities, University of Naples Federico II, Italy
| | | | - Erik Fertuck
- City University of New York Graduate Center, New York, NY, USA
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16
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Gandy S, Forstmann M, Carhart-Harris RL, Timmermann C, Luke D, Watts R. The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health. Health Psychol Open 2020; 7:2055102920978123. [PMID: 33335742 PMCID: PMC7724423 DOI: 10.1177/2055102920978123] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Therapeutic psychedelic administration and contact with nature have been
associated with the same psychological mechanisms: decreased
rumination and negative affect, enhanced psychological connectedness
and mindfulness-related capacities, and heightened states of awe and
transcendent experiences, all processes linked to improvements in
mental health amongst clinical and healthy populations. Nature-based
settings can have inherently psychologically soothing properties which
may complement all stages of psychedelic therapy (mainly preparation
and integration) whilst potentiating increases in nature relatedness,
with associated psychological benefits. Maximising enhancement of
nature relatedness through therapeutic psychedelic administration may
constitute an independent and complementary pathway towards
improvements in mental health that can be elicited by
psychedelics.
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Affiliation(s)
- Sam Gandy
- Centre for Psychedelic Research,
Imperial College London, UK
- Synthesis Institute, The
Netherlands
- Sam Gandy, Synthesis Institute B.V.,
Korte Leidsedwarsstraat 12, 1017 RC Amsterdam, The Netherlands.
| | | | | | | | - David Luke
- Centre for Psychedelic Research,
Imperial College London, UK
- University of Greenwich, UK
| | - Rosalind Watts
- Centre for Psychedelic Research,
Imperial College London, UK
- Synthesis Institute, The
Netherlands
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17
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Dhaliwal K, Danzig A, Fineberg SK. Improving Research Practice for Studying Borderline Personality Disorder: Lessons From the Clinic. ACTA ACUST UNITED AC 2020; 4:2470547020912504. [PMID: 32518886 PMCID: PMC7254581 DOI: 10.1177/2470547020912504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/23/2020] [Indexed: 12/25/2022]
Abstract
Borderline personality disorder is an often misunderstood and underdiagnosed mental illness characterized in part by affective lability. Clinicians’ unique understanding of the disorder has allowed them to develop disorder-specific approaches to treatment. In this review, we highlight how borderline personality disorder research can benefit from greater engagement with key disorder-specific features, including symptom variability and interpersonal sensitivity. In addition, we propose that research which employs interactive tasks will be more reflective of the kinds of volatility found in the real-life situations. Finally, we discuss how mixed-methodology can serve as a way for recovery-oriented research to practice the very ideals and recommendations it suggests. We use a patient case to contextualize each section. As interest in borderline personality disorder continues to grow, an intentional emphasis on a person-centered, recovery-focused, and disorder-specific approach to research is needed.
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Affiliation(s)
- Khushwant Dhaliwal
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ayala Danzig
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sarah K Fineberg
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
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18
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Sørensen KD, Wilberg T, Berthelsen E, Råbu M. Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be. Front Psychol 2020; 10:2879. [PMID: 31920894 PMCID: PMC6928111 DOI: 10.3389/fpsyg.2019.02879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretative-phenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process. Results: The super ordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.
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Affiliation(s)
- Kristine Dahl Sørensen
- Group Therapy Team, Aust-Agder County Outpatient Psychiatric Unit, Sorlandet Hospital, Arendal, Norway
| | - Theresa Wilberg
- Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind Berthelsen
- Aust-Agder County Outpatiet Psychiatric Unit, Sorlandet Hospital, Arendal, Norway
| | - Marit Råbu
- Department of Psychology, University of Oslo, Oslo, Norway
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19
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Kvarstein EH, Folmo E, Antonsen BT, Normann-Eide E, Pedersen G, Wilberg T. Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT). Front Psychiatry 2020; 11:691. [PMID: 32792996 PMCID: PMC7391122 DOI: 10.3389/fpsyt.2020.00691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mentalization-based treatment (MBT) is an evidence-based treatment for borderline personality disorder (BPD). Differences in treatment outcomes related to specific capacity of social cognition need further attention. This study aimed to investigate social cognition as a predictor of outcome. METHOD The study included 31 BPD patients who completed a test of social cognition (Movie for the Assessment of Social Cognition, MASC) before outpatient MBT. The MASC-scores indicated a person's theory of mind (ToM) and different error-types. During treatment repeated self-reports of alliance and clinical outcomes (symptoms, interpersonal problems, social functioning) were applied. Longitudinal analyses were based on Linear Mixed Models (n = 24). RESULTS The most frequent error-type was excessive ToM (hypermentalizing). Higher levels of excessive ToM were associated with greater improvement of alliance over time and good clinical outcomes. Insufficient ToM errors and low levels of accurate cognitive ToM responses were both associated with poorer improvement over time. The subgroup with frequent insufficient ToM errors had a larger total number of ToM errors. Insufficient ToM errors were associated with more childhood trauma, comorbid avoidant PD traits and/or PTSD, extensive prior treatment, and/or treatment irregularity. CONCLUSION This study demonstrates considerable variation of social cognitive capacity among BPD patients and good outcomes for patients with mainly ToM errors of hypermentalizing. It also indicates that poorly responding patients may represent a cohort with more complex problems of social cognition and insufficient mentalizing.
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Affiliation(s)
- Elfrida H Kvarstein
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Folmo
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Eivind Normann-Eide
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theresa Wilberg
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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20
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Czelusta KL, Idicula S, Laney E, Nazir S, Udoetuk S. Management of Borderline Personality Disorder. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20191203-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Kettner H, Gandy S, Haijen ECHM, Carhart-Harris RL. From Egoism to Ecoism: Psychedelics Increase Nature Relatedness in a State-Mediated and Context-Dependent Manner. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5147. [PMID: 31888300 PMCID: PMC6949937 DOI: 10.3390/ijerph16245147] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/30/2023]
Abstract
(1) Background: There appears to be a growing disconnection between humans and their natural environments which has been linked to poor mental health and ecological destruction. Previous research suggests that individual levels of nature relatedness can be increased through the use of classical psychedelic compounds, although a causal link between psychedelic use and nature relatedness has not yet been established. (2) Methods: Using correlations and generalized linear mixed regression modelling, we investigated the association between psychedelic use and nature relatedness in a prospective online study. Individuals planning to use a psychedelic received questionnaires 1 week before (N = 654), plus one day, 2 weeks, 4 weeks, and 2 years after a psychedelic experience. (3) Results: The frequency of lifetime psychedelic use was positively correlated with nature relatedness at baseline. Nature relatedness was significantly increased 2 weeks, 4 weeks and 2 years after the psychedelic experience. This increase was positively correlated with concomitant increases in psychological well-being and was dependent on the extent of ego-dissolution and the perceived influence of natural surroundings during the acute psychedelic state. (4) Conclusions: The here presented evidence for a context- and state-dependent causal effect of psychedelic use on nature relatedness bears relevance for psychedelic treatment models in mental health and, in the face of the current ecological crisis, planetary health.
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