1
|
Smith L, Hunt K, Parker S, Camp J, Stewart C, Morris A. Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6334. [PMID: 37510567 PMCID: PMC10379026 DOI: 10.3390/ijerph20146334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. METHOD This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. RESULTS Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. DISCUSSION Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.
Collapse
Affiliation(s)
- Lindsay Smith
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Katrina Hunt
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Sam Parker
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Jake Camp
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Catherine Stewart
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Andre Morris
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| |
Collapse
|
2
|
Guillén V, Arnal A, Pérez S, Garcia-Alandete J, Fernandez-Felipe I, Grau A, Botella C, Marco JH. Family connections in the treatment of relatives of people with eating disorders and personality disorders: study protocol of a randomized control trial. BMC Psychol 2023; 11:88. [PMID: 36998024 PMCID: PMC10064734 DOI: 10.1186/s40359-023-01138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious disorders that significantly affect not only the lives of patients, but also those of their family members who often experience high levels of burden, suffering and helplessness. If, in addition to ED, the patient has a personality disorder (PD), the psychological distress experienced by family members can be devastating. However, few treatments have been developed for family members of people with ED and PD. Family Connections (FC) is a programme that has been shown to be effective for family members of people with borderline personality disorder. The overall aims of this work are: (a) to adapt FC for application to family members of patients with BPD-PD (FC: ED-PD); (b) to analyse, in a randomised controlled clinical trial, the efficacy of this programme in a Spanish population, compared to a control condition consisting of treatment as usual optimised treatment (TAU-O); (c) to analyse the feasibility of the intervention protocol; (d) to analyse whether the changes that may occur in relatives are related to improvements in the family climate and/or improvements observed in patients; and (e) to analyse the perceptions and opinions of relatives and patients about the two intervention protocols. METHODS The study uses a two-arm randomised controlled clinical trial with two experimental conditions: adaptation of FC programme (FC: ED-PD) or Treatment as usual optimised (TAU-O). Participants will be family members of patients who meet DSM-5 criteria for ED and PD or dysfunctional personality traits. Participants will be assessed before and after treatment and at one-year follow-up. The intention-to-treat principle will be used when analysing the data. DISCUSSION The results obtained are expected to confirm the effectiveness of the programme and its good acceptance by family members. Trial registration ClinicalTrials.gov Identifier: NCT05404035. Accepted: May 2022.
Collapse
Affiliation(s)
- Verónica Guillén
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain.
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain.
| | - Antonio Arnal
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Sandra Pérez
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Joaquín Garcia-Alandete
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Isabel Fernandez-Felipe
- Universitat Jaume I de Castelló, Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón de la Plana, Castellón, Spain
| | - Antoni Grau
- Ita-Salud Mental, Especialistas en Salud Mental, C/Tavern, 61, 08006, Barcelona, Spain
| | - Cristina Botella
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
- Universitat Jaume I de Castelló, Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón de la Plana, Castellón, Spain
| | - José Heliodoro Marco
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Abdigaravand M, Goudarzi F, Hasanvand S, Birjandi M, Galehdar N, Hojati Z. The Effect of Education and Telephone Follow-up on the Burden of Family Caregivers of Patients With Cancer. SAGE Open Nurs 2023; 9:23779608231170444. [PMID: 37187546 PMCID: PMC10176539 DOI: 10.1177/23779608231170444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/18/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Family caregivers of patients with cancer face a care burden due to the responsibilities and problems of providing care to the patients. Applying appropriate strategies to reduce the burden is essential. Objective The study aimed to determine the effect of education and telephone follow-up on family caregivers' burden on patients with cancer. Methods In this quasi-experimental study, 69 family caregivers of patients with cancer referred to only one chemotherapy center of a hospital in Lorestan province in Iran were recruited by convenience sampling method. They were randomly assigned to intervention (n = 33) and control (n = 36) groups. For the intervention group, two face-to-face training sessions and six telephone counseling sessions were held related to the care of the patients and self-care. The control group received only routine care. The family caregiver burden was measured by Novak and Gast Caregiver Burden Inventory (1989) completed before, immediately, and 6 weeks after the study. Data were analyzed by SPSS21 using independent t-tests, paired t-tests, and repeated measures. Results Both groups were homogeneous regarding demographic characteristics and the baseline care burden. The caregiver burden decreased significantly in the intervention group, so its score was 77.33 ± 8.49, 58.93 ± 8.03, and 52.78 ± 6.86 before the study, immediately after and 6 weeks later, respectively (p < .001). In the control group, there were no significant changes. Conclusion Education and telephone counseling reduced the burden on family caregivers. Therefore, this type of support is beneficial for providing holistic care and preserving the health of family caregivers.
Collapse
Affiliation(s)
| | - Fateme Goudarzi
- Social Determinants of Health Research
Center, School of Nursing and Midwifery, Lorestan University of Medical
Sciences, Khorramabad, Iran
| | - Shirin Hasanvand
- Social Determinants of Health Research
Center, School of Nursing and Midwifery, Lorestan University of Medical
Sciences, Khorramabad, Iran
| | - Mehdi Birjandi
- Nutritional Health Research Center,
School of Health and Nutrition, Lorestan University of Medical
Sciences, Khorramabad, Iran
| | - Nasrin Galehdar
- Social Determinants of Health Research
Center, Paramedical Faculty, Lorestan University of Medical
Sciences, Khorramabad, Iran
| | - Zohreh Hojati
- Social Determinants of Health Research
Center, Boroujerd school of Nursing, Lorestan University of Medical
Sciences, Khorramabad, Iran
| |
Collapse
|
4
|
Fernández-Felipe I, Guillén V, Castilla D, Navarro-Haro MV, García-Palacios A. A smartphone application of "Family Connections" to increase the use of skills and improve psychological symptoms in relatives of people with borderline personality disorder: A study protocol for a randomized controlled trial. Internet Interv 2022; 29:100546. [PMID: 35607385 PMCID: PMC9123206 DOI: 10.1016/j.invent.2022.100546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Verónica Guillén
- University of Valencia and Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Azucena García-Palacios
- Universitat Jaume I and Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| |
Collapse
|
5
|
Flujas-Contreras JM, García-Palacios A, Gómez I. Parenting Intervention for Psychological Flexibility and Emotion Regulation: Clinical Protocol and an Evidence-Based Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095014. [PMID: 35564408 PMCID: PMC9101648 DOI: 10.3390/ijerph19095014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
Psychological flexibility has been found as a protective factor for several psychological problems, including the field of parenting. The present study aims to illustrate a clinical protocol, session by session, for the promotion of parental psychological flexibility and emotion regulation in a case study. The clinical protocol is based on third-wave behavior therapy in a brief intervention of four sessions. The intervention is presented in a clinical case of a mother with a child diagnosed with Oppositional Defiant Disorder. Both mother and child experienced problems with emotional regulation and psychological flexibility. The results show clinically significant improvements in psychological flexibility, emotional regulation, and stress parenting in the mother both after the intervention and at follow-up. In the child, emotional perspective-taking skills, acceptance, and valued actions improved. The case illustrates in detail the application of different strategies of acceptance, mindfulness, emotion regulation, and emotional defusion applicable to parenting. Clinical implications are discussed.
Collapse
Affiliation(s)
- Juan M. Flujas-Contreras
- Department of Psychology, University of Almeria, 04120 Almeria, Spain;
- Health Research Centre (CEINSA/UAL), University of Almeria, 04120 Almeria, Spain
- Correspondence:
| | - Azucena García-Palacios
- Department of Psychology, University Jaume I, 12071 Castellon, Spain;
- CIBER of Physiopathology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Inmaculada Gómez
- Department of Psychology, University of Almeria, 04120 Almeria, Spain;
- Health Research Centre (CEINSA/UAL), University of Almeria, 04120 Almeria, Spain
| |
Collapse
|
6
|
Guillén V, Fonseca-Baeza S, Fernández-Felipe I, Botella C, Baños R, García-Palacios A, Marco J. Effectiveness of family connections intervention for family members of persons with personality disorders in two different formats: Online vs face-to-face. Internet Interv 2022; 28:100532. [PMID: 35646607 PMCID: PMC9136357 DOI: 10.1016/j.invent.2022.100532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Personality disorders (PD) have a serious impact on the lives of individuals who suffer from them and those around them. It is common for family members to experience high levels of burden, anxiety, and depression, and deterioration in their quality of life. It is curious that few interventions have been developed for family members of people with PD. However, Family Connections (FC) (Hoffman and Fruzzetti, 2005) is the most empirically supported intervention for family members of people with Borderline Personality Disorder (BPD). AIM The aim of this study is to explore the effectiveness of online vs face-to-face FC. Given the current social constraints resulting from SARS-CoV-2, interventions have been delivered online and modified. METHOD This was a non-randomized pilot study with a pre-post evaluation and two conditions: The sample consisted of 45 family members distributed in two conditions: FC face-to-face (20) performed by groups before the pandemic, and FC online (25), performed by groups during the pandemic. All participants completed the evaluation protocol before and after the intervention. RESULTS There is a statistically significant improvement in levels of burden (η 2 = 0.471), depression, anxiety, and stress (η 2 = 0.279), family empowerment (η 2 = 0.243), family functioning (η 2 = 0.345), and quality of life (μ2 η 2 = 0.237). There were no differences based on the application format burden (η 2 = 0.134); depression, anxiety, and stress (η 2 = 0.087); family empowerment (η 2 = 0,27), family functioning (η 2 = 0.219); and quality of life (η 2 = 0.006), respectively). CONCLUSIONS This study provides relevant data about the possibility of implementing an intervention in a sample of family members of people with PD in an online format without losing its effectiveness. During the pandemic, and despite the initial reluctance of family members and the therapists to carry out the interventions online, this work shows the effectiveness of the results and the satisfaction of the family members. These results are particularly relevant in a pandemic context, where there was no possibility of providing help in other ways. All of this represents a great step forward in terms of providing psychological treatment.
Collapse
Affiliation(s)
- V. Guillén
- Universidad de Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain,Corresponding author at: Dep. of Personality, Evaluation and Psychological Treatments, University of Valencia, Av. Blasco Ibañez 21, 46010, Spain.
| | | | - I. Fernández-Felipe
- Universitat Jaume I de Castellón, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - C. Botella
- Universitat Jaume I de Castellón, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - R. Baños
- Universidad de Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - A. García-Palacios
- Universitat Jaume I de Castellón, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - J.H. Marco
- Universidad de Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| |
Collapse
|
7
|
Hughes AJ, Botanov Y, Beier M. Dialectical Behavior Therapy Skills Training for Individuals with Multiple Sclerosis and their Support Partners: A Pilot Randomized Controlled Trial. Mult Scler Relat Disord 2022; 59:103481. [DOI: 10.1016/j.msard.2021.103481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/06/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
|
8
|
Guillén V, Díaz-García A, Mira A, García-Palacios A, Escrivá-Martínez T, Baños R, Botella C. Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review. FAMILY PROCESS 2021; 60:134-144. [PMID: 32304101 DOI: 10.1111/famp.12537] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full-text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.
Collapse
Affiliation(s)
- Verónica Guillén
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Amanda Díaz-García
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
| | - Azucena García-Palacios
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Tamara Escrivá-Martínez
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
| | - Rosa Baños
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Cristina Botella
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| |
Collapse
|
9
|
Kemper M, Gunia H, Haberstroh J. Evaluation einer Mehrfamiliengruppe für Patient_innen mit einer Borderline-Persönlichkeitsstörung und ihre Angehörigen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2021. [DOI: 10.1026/1616-3443/a000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund. Familiäre Konflikte und dysfunktionale Verhaltensweisen spielen eine entscheidende Rolle bei der Entstehung und Aufrechterthaltung von Borderline-Persönlichkeitsstörungen (BPS). Auf der Grundlage der Dialektisch-Behavioralen Therapie (DBT) berücksichtigte Alan Fruzzetti die genannten Faktoren in einem transaktionalen Entstehungmodell. Um BPS-Betroffenen und deren Angehörigen Strategien für eine funktionalere Emotions- und Interaktionsbewältigung an die Hand zu geben, entwickelte Alan Fruzzetti DBT-Familien-Skills. Fragestellung. Die Wirksamkeit dieser Fertigkeiten als therapeutische Intervention im Rahmen eines Mehrfamiliensettings wurde im Rahmen der vorliegenden Pilotstudie evaluiert. Methode. Mittels Tagebuch- und Sitzungsabfragen wurden prozessuale Daten der psychischen Beanspruchung und Anwendungshäufigkeit von DBT-Familien-Skills (AFS) erhoben. Ergebnisse. Via Trendanalysen konnten Hinweise auf hypothesenkonforme Beanspruchungsreduktionen und eine Zunahme der AFS über den zeitlichen Gruppenverlauf bei BPS-Betroffenen und Angehörigen identifiziert werden. Schlussfolgerung. Die Ergebnisse der Pilotstudie liefern erste Hinweise, dass die in einem Mehrfamilienformat angebotenen DBT-Familien-Skills zu einer Reduktion der psychischen Beanspruchung der BPS-Betroffenen und Angehörigen beitragen.
Collapse
Affiliation(s)
| | | | - Julia Haberstroh
- Professur für Psychologische Alternsforschung, Fakultät II, Institut für Psychologie, Universität Siegen
| |
Collapse
|
10
|
Efficacy of "Family Connections", a program for relatives of people with borderline personality disorder, in the Spanish population: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:302. [PMID: 32539740 PMCID: PMC7296953 DOI: 10.1186/s12888-020-02708-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) experience significant affect regulation difficulties that cause serious consequences in their work, emotional, and social environments. This dysfunctional pattern also produces great suffering and a heavy burden on their relatives. Fortunately, some studies show that treatment of relatives of people with BPD begins to be important in the patients' recovery and in improving family dynamics. One of the treatments that has obtained the most empirical support is Family connections (FC). This 12-session program is an adaptation of different Dialectical Behavior Therapy strategies. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre-post treatment and follow-up assessments. The results of these studies and subsequent replications showed an improvement in family attitudes and caregiver burnout. Our research team adapted FC for delivery in the Spanish population. We intend to test the efficacy of this program versus a treatment as usual condition. Moreover, we aim to test the efficacy of this program and study its effectiveness (in terms of participants' acceptance). This paper presents the study protocol. METHODS The study is a randomized controlled trial. The participants will be recruited in a Personality Disorders Unit and randomly assigned to one of two treatment conditions: Family Connections group (FC) or Treatment As Usual (TAU). Primary outcome measures will be the BAS and FAD-GFS. Secondary outcomes will include DASS-21, FES, GS, and QLI. Participants' treatment acceptance and degree of satisfaction will also be measured. Participants will be assessed at pre-, post-treatment, and 6-month follow-up. Intention to treat and per protocol analyses will be performed. DISCUSSION This is the first study on FC for relatives of people with borderline personality disorder (BPD) compared to an active condition (TAU), and this is the first time relatives' and patients' data will be analyzed. In addition, it is the first study to test the efficacy of the program in Spain. This intervention could contribute to improving the efficiency and effectiveness of current treatment programs for relatives of people with BPD, help to decrease burden, and improve the family connection. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04160871. Registered November 15th 2019.
Collapse
|
11
|
Navarro-Haro MV, López-del-Hoyo Y, Campos D, Linehan MM, Hoffman HG, García-Palacios A, Modrego-Alarcón M, Borao L, García-Campayo J. Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference. PLoS One 2017; 12:e0187777. [PMID: 29166665 PMCID: PMC5699841 DOI: 10.1371/journal.pone.0187777] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/25/2017] [Indexed: 11/19/2022] Open
Abstract
Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants' attention and gives users the illusion of "being there" in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high "presence" in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback. VR is a technology with potential to increase computerized dissemination of DBT® skills training modules. Future research is warranted.
Collapse
Affiliation(s)
| | - Yolanda López-del-Hoyo
- Universidad de Zaragoza, Zaragoza, Spain
- Red de Investigación en Atención Primaria (REDIAPP), Zaragoza, Spain
| | | | - Marsha M. Linehan
- Behavioral Research & Therapy Clinics, University of Washington, Seattle, WA, United States of America
| | - Hunter G. Hoffman
- Virtual Reality Research Center at the Human Photonics Lab, Mechanical Engineering, University of Washington Seattle, Seattle, WA, United States of America
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Madrid, Spain
| | | | - Luis Borao
- Red de Investigación en Atención Primaria (REDIAPP), Zaragoza, Spain
| | - Javier García-Campayo
- Red de Investigación en Atención Primaria (REDIAPP), Zaragoza, Spain
- ISS Aragón. Hospital Universitario Miguel Servet, Zaragoza, Spain
| |
Collapse
|