Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention

Borderline Personality Disorder and Emotion Dysregulation

Research

Ausias Cebolla¹  Carlos Schmidt²  Elisabet Domínguez-Clavé³  Joaquim Soler⁴  Juan Carlos Pascual⁴  Elisabet Casellas-Pujol⁴  Matilde Elices⁵  David Alvear⁶  Anna Muro⁷ 

[1] Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, University of Valencia UV, Valencia, Spain;CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain;Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain;Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain;Institut d’Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain;Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain;Universitat Autònoma de Barcelona (UAB), Barcelona, Spain;Institut d’Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain;Institut d’Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain;Institute Mar of Medical Research, IMIM, Barcelona, Spain;Universidad del País Vasco/Euskal Herriko Unibertsitatea, leioa, Spain;Universitat Autònoma de Barcelona (UAB), Barcelona, Spain;Department of Basic, Developmental and Educational Psychology, Universitat Autònoma de Barcelona Serra Húnter Programme, Generalitat de Catalunya, Barcelona, Spain;

关键词: Borderline personality disorder;    Long-lasting BPD;    Feasibility;    Acceptability;    Skills training;    Positive psychology;    Dialectical behavior therapy;    Contextual approach;   

DOI  :  10.1186/s40479-022-00204-x

 received in 2022-08-10, accepted in 2022-11-12,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundLong-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties.MethodsThis was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability.ResultsThe following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%.ConclusionsThe intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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