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Shen JE, Huang YH, Huang HC, Liu HC, Lee TH, Sun FJ, Huang CR, Liu SI. Psychometric properties of the Chinese Mandarin version of the Borderline Symptom List, short form (BSL-23) in suicidal adolescents. Borderline Personal Disord Emot Dysregul 2023; 10:23. [PMID: 37553717 PMCID: PMC10411024 DOI: 10.1186/s40479-023-00230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The short form of the Borderline Symptom List (BSL-23) is a self-rated instrument developed from the initial 95-item German version of the Borderline Symptom List (BSL-95). It is widely used among Chinese adults, but its applicability, factor structure and validity remain uncertain in adolescents. This study aimed to evaluate the psychometric properties of the Chinese Mandarin version of the BSL-23 in a sample of suicidal adolescents. METHODS The Chinese Mandarin BSL-23 was given to 279 outpatient adolescents with self-injurious thoughts or behaviors. The factor structure, reliability, convergent validity, criterion-related validity and cut-off value were investigated. RESULTS The Chinese Mandarin version of the BSL-23 demonstrated a one-factor structure and replicated the original version. The scale had high reliability and good test-retest stability. The Chinese Mandarin BSL-23 was correlated with depression, hopelessness, impulsivity, emotional dysregulation, self-esteem, loneliness, childhood trauma and parental bonding patterns evaluated with a variety of scales. The measure showed good criterion-related validity and predictive accuracy (AUC = 0.87) for self-injurious and suicidal adolescents with borderline personality disorder (BPD) at a cut-off point of 60/61 (mean score 2.60/2.65), with a sensitivity of 0.76 and specificity of 0.83. CONCLUSIONS The Chinese Mandarin version of the BSL-23 is a reliable and valid self-reported instrument to assess BPD symptomatology among suicidal adolescents.
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Affiliation(s)
- Jui-En Shen
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Hsin Huang
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Han Lee
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan.
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
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Lin Y, Hsu CC, Lin CJ, Kuroda R, Chiang DL, Lai F, Wu SI. Neurobiological mechanisms of dialectical behavior therapy and Morita therapy, two psychotherapies inspired by Zen. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02644-3. [PMID: 37145166 DOI: 10.1007/s00702-023-02644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
Psychotherapy is a learning process. Updating the prediction models of the brain may be the mechanism underlying psychotherapeutic changes. Although developed in different eras and cultures, dialectical behavior therapy (DBT) and Morita therapy are influenced by Zen principles, and both emphasize the acceptance of reality and suffering. This article reviews these two treatments, their common and distinct therapeutic factors, and their neuroscientific implications. Additionally, it proposes a framework that includes the predictive function of the mind, constructed emotions, mindfulness, therapeutic relationship, and changes enabled via reward predictions. Brain networks, including the Default Mode Network (DMN), amygdala, fear circuitry, and reward pathways, contribute to the constructive process of brain predictions. Both treatments target the assimilation of prediction errors, gradual reorganization of predictive models, and creation of a life with step-by-step constructive rewards. By elucidating the possible neurobiological mechanisms of these psychotherapeutic techniques, this article is expected to serve as the first step towards filling the cultural gap and creating more teaching methods based on these concepts.
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Affiliation(s)
- Ying Lin
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd, Taipei, 10449, Taiwan
| | - Chen-Chi Hsu
- Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd, Taipei, 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chen-Ju Lin
- Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd, Taipei, 10449, Taiwan
- Institute of Health and Welfare Policy, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Reiko Kuroda
- Division for Environment, Health and Safety, The University of Tokyo, Tokyo, Japan
| | - Dai-Lun Chiang
- Financial Technology Applications Program, Ming-Chuan University, Taoyuan, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Shu-I Wu
- Department of Psychiatry, MacKay Memorial Hospital, No. 92, Section 2, Chung-Shan North Rd, Taipei, 10449, Taiwan.
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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Relationships of Homophobic Bullying Victimization during Childhood with Borderline Personality Disorder Symptoms in Early Adulthood among Gay and Bisexual Men: Mediating Effect of Depressive Symptoms and Moderating Effect of Family Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084789. [PMID: 35457655 PMCID: PMC9027503 DOI: 10.3390/ijerph19084789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
This study investigated (1) the associations of homophobic bullying victimization in childhood with borderline personality disorder (BPD) symptoms in early adulthood among gay and bisexual men; (2) the mediating effect of depressive symptoms on the association between homophobic bullying victimization and BPD symptoms, and (3) the moderating effects of perceived family support on the association between homophobic bullying victimization and BPD symptoms. A total of 500 gay or bisexual men aged between 20 and 25 years were recruited into this study. The experiences of physical, verbal and social relationship bullying victimization during childhood were evaluated using the Mandarin Chinese version of the School Bullying Experience Questionnaire. The experiences of cyberbullying victimization during childhood were evaluated using the Cyberbullying Experiences Questionnaire. BPD symptoms were assessed using the Borderline Symptom List. Depressive symptoms were examined using the Center for Epidemiologic Studies Depression Scale. Perceived family support was evaluated using the Family Adaptation, Partnership, Growth, Affection, and Resolve index. The results of mediation analyses demonstrated that all the types of homophobic bullying victimization in childhood were directly associated with BDP symptoms in young adulthood as well as indirectly associated with BPD symptoms through the mediation of depressive symptoms. The results of moderation analyses demonstrated that the association between homophobic bullying victimization and BPD symptoms decreased when the individuals had more family support. Intervention programs to reduce homophobic bullying victimization and enhance family support for gay and bisexual men and their families are necessary. Interventions to improve depressive and BPD symptoms among gay and bisexual men are also necessary, especially for those who experienced homophobic bullying victimization during childhood.
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Keng SL, Mohd Salleh Sahimi HB, Chan LF, Woon L, Eu CL, Sim SH, Wong MK. Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes. BMC Psychiatry 2021; 21:486. [PMID: 34607589 PMCID: PMC8489091 DOI: 10.1186/s12888-021-03500-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
AIM/BACKGROUND Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia. METHODS Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention. RESULTS There were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants' feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial. CONCLUSION These preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.
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Affiliation(s)
- Shian-Ling Keng
- Division of Social Science, Yale-NUS College, Singapore, Singapore.
| | - Hajar Binti Mohd Salleh Sahimi
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras, Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras, Kuala Lumpur, Malaysia
| | - Luke Woon
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras, Kuala Lumpur, Malaysia
| | - Choon Leng Eu
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Cheras, Kuala Lumpur, Malaysia
| | - Su Hua Sim
- Department of Psychology, HELP University, Bukit Damansara, Kuala Lumpur, Malaysia
| | - Man Kuan Wong
- Department of Psychology, HELP University, Bukit Damansara, Kuala Lumpur, Malaysia
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