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Drews-Windeck E, Greenwood K, Cavanagh K. A systematic review and meta-analysis of digital interventions targeted at individuals with borderline personality disorder (BPD), emotionally unstable personality disorder (EUPD), and related symptoms. J Clin Psychol 2023. [PMID: 37185891 DOI: 10.1002/jclp.23523] [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: 04/29/2022] [Revised: 02/22/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The present review investigates the impact of digital interventions for individuals with features of borderline personality disorder (BPD)/emotional unstable personality disorder (EUPD) as digital interventions show promise as therapeutic tools in underserved groups. BPD/EUPD features are identified as clinically relevant, yet previous reviews on the use of digital interventions fail to include subthreshold symptomatology. METHODS Five online databases were searched for terminology in three categories: BPD/EUPD and related symptoms, mental-health interventions, and digital technology. Additionally, four relevant journals and two trial registers were searched for additional papers meeting the inclusion criteria. RESULTS Twelve articles met all inclusion criteria. Meta-analyses revealed statistically significant differences in symptom measures between intervention and control groups at postintervention and decreases in BPD/EUPD symptomatology and well-being from pre- to postintervention. Service users' engagement, satisfaction, and acceptability of interventions were high. Results support the previous literature on the value of using digital interventions in populations with BPD/EUPD. CONCLUSION Overall, it was identified that digital interventions show promise for successful implementation with this population.
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Affiliation(s)
- Elea Drews-Windeck
- School of Psychology, The University of Sussex, Brighton, UK
- Research & Development and Digital Services, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kathryn Greenwood
- School of Psychology, The University of Sussex, Brighton, UK
- Research & Development and Digital Services, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kate Cavanagh
- School of Psychology, The University of Sussex, Brighton, UK
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Dinu B, Dark F. Cognitive remediation therapy: is it a feasible and acceptable psychological treatment for borderline personality disorder? Australas Psychiatry 2022:10398562221136774. [PMID: 36341496 DOI: 10.1177/10398562221136774] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive remediation (CR) is increasingly being used to address the cognitive impairment that can occur in people diagnosed with borderline personality disorder (BPD). This study aimed to understand attitudes towards CR in this service user group from the perspective of the person with the diagnosis and clinicians involved in their care. METHOD Anonymous online surveys were made available to people with a diagnosis of BPD in a public mental health service and clinicians of the same service. RESULTS Thirty-three percent of service users with a diagnosis of BPD responded to the survey. Most respondents (93%) expressed a desire to improve their cognition and were interested in cognitive remediation therapy (83%). Most staff (86%) recognised cognitive impairment can occur in people with a diagnosis of BPD and the same proportion believed cognitive skills impact on patient's emotional and mental health. Seventy percent of respondents believed CR would be useful for this service user group. CONCLUSIONS It is important that interventions to address the cognitive impairment associated with BPD are made available and that they are well integrated into the person's overall care plan.
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Affiliation(s)
- Bianca Dinu
- 157829Metro South Hospital and Health Service, Woolloongabba, QLD, Australia
| | - Frances Dark
- University of Queensland, Brisbane, QLD, Australia
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Lakeman R, King P, Hurley J, Tranter R, Leggett A, Campbell K, Herrera C. Towards online delivery of Dialectical Behaviour Therapy: A scoping review. Int J Ment Health Nurs 2022; 31:843-856. [PMID: 35048482 PMCID: PMC9305106 DOI: 10.1111/inm.12976] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 12/31/2022]
Abstract
Dialectical Behaviour Therapy (DBT) programmes are often the only available treatment for people diagnosed with borderline personality disorder and were rapidly converted to online delivery during the COVID-19 pandemic. Limited research exists surrounding how the major elements of DBT are delivered in an online environment. This scoping review considered the operationalization of online delivery of DBT and its effectiveness. EBSCO host databases were searched using free text. Of 127 papers, 11 studies from 2010 to 2021 investigating online DBT for any clinical population were included in the review. A narrative synthesis of papers selected was undertaken. Seven articles reported results from five clinical trials (n = 437). Most adaptations mirrored face-to-face programmes although there was considerable variation in how therapy was facilitated. Attendance was reported to be greater online with comparable clinical improvements to face-to-face for those who remained in therapy. Additional challenges included managing risk, therapist preparedness and technology difficulties. Online delivery of DBT programmes is feasible and may be more accessible, acceptable and as safe and effective as face-to-face delivery. However, mirroring face to face delivery in an online environment may not be the most effective and efficient way to adapt DBT to online provision. Research is needed to identify areas which require further adaptation.
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Affiliation(s)
- Richard Lakeman
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Peter King
- Australian DBT Institute, Southport, Queensland, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
| | - Richard Tranter
- Mid North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Andrew Leggett
- Mid North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Katrina Campbell
- Faculty of Health, Southern Cross University, Bilinga, Queensland, Australia
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The Use of Computer-Driven Technologies in the Treatment of Borderline Personality Disorder: A Systematic Review. J Clin Med 2022; 11:jcm11133685. [PMID: 35806970 PMCID: PMC9267789 DOI: 10.3390/jcm11133685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to perform a systematic review of the effectiveness of computer-driven technologies for treatment of patients suffering from BPD. A systematic literature review was conducted using the Pubmed, EMBASE, PsycNET (PsycINFO), CINAHL and Google Scholar electronic databases for the period from their inception dates until 2022. Thirty studies were selected for abstract screening. Seven studies were excluded for not meeting inclusion criteria. The remaining 23 studies were fully assessed, and 12 were excluded. Therefore, 11 studies were included in the analysis of the effectiveness of computer-driven technologies, which encompassed mobile applications, telehealth interventions, internet-based interventions, virtual reality MBT and dialogue-based integrated interventions. Computer-driven interventions are showing signs of effectiveness in the treatment of BPD symptoms. The limited number of articles found on the subject demonstrates a need for further exploration of this subject.
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Zimmerman M, Ward M, D'Avanzato C, Tirpak JW. Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment. J Pers Disord 2022; 36:277-295. [PMID: 34747648 DOI: 10.1521/pedi_2021_35_539] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Madeline Ward
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Catherine D'Avanzato
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Julianne Wilner Tirpak
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
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A systematic quality rating of available mobile health apps for borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:17. [PMID: 35642024 PMCID: PMC9158356 DOI: 10.1186/s40479-022-00186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health apps (MHAs) may offer a mean to overcome treatment barriers in Borderline Personality Disorder (BPD) mental health care. However, MHAs for BPD on the market lack transparency and quality assessment. METHODS European app stores were systematically searched, and two independent trained reviewers extracted relevant MHAs. Employed methods and privacy and security details documentation of included MHAs were extracted. MHAs were then assessed and rated using the German version of the standardized Mobile Application Rating Scale (MARS-G). Mean values and standard deviations of all subscales (engagement, functionality, aesthetics, information, and therapeutic gain) and correlations with user ratings were calculated. RESULTS Of 2977 identified MHAs, 16 were included, showing average quality across the four main subscales (M = 3.25, SD = 0.68). Shortcomings were observed with regard to engagement (M = 2.87, SD = 0.99), potential therapeutic gain (M = 2.67, SD = 0.83), existing evidence base (25.0% of included MHAs were tested empirically), and documented privacy and security details. No significant correlations were found between user ratings and the overall total score of the MARS-G or MARS-G main subscales. CONCLUSIONS Available MHAs for BPD vary in quality and evidence on their efficacy, effectiveness, and possible adverse events is scarce. More substantial efforts to ensure the quality of MHAs available for patients and a focus on transparency, particularly regarding privacy and security documentation, are necessary.
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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.
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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
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Abstract
PURPOSE OF REVIEW Provision of mental health services through digital technologies (e-mental health) can potentially expand access to treatments for personality disorders (PDs). We evaluated studies on e-mental health for PDs published over the last 3 years (2019-2022). RECENT FINDINGS Studies published in English that used e-mental health to treat people with PDs or PD-related symptoms were identified. We identified 19 studies, including four randomized controlled trials and one meta-analysis. Most interventions were based on Dialectical Behavior Therapy and delivered through smartphone applications for adults with Borderline Personality Disorder [BPD] or related symptoms. User experiences of the interventions were generally positive. Evidence for efficacy was limited. The current literature on e-mental health for PDs is limited in scope. Research in understudied populations and randomized controlled trials designed to establish efficacy are warranted. It is not yet clear whether e-mental health may be helpful for the treatment of PDs.
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Affiliation(s)
- Qiang Xie
- Department of Counseling Psychology, University of Wisconsin-Madison, 335 Education Building, 1000 Bascom Mall, Madison, WI, 53706, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, 335 Education Building, 1000 Bascom Mall, Madison, WI, 53706, USA.
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA.
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Alavi N, Stephenson C, Rivera M. Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial. JMIR Ment Health 2021; 8:e27308. [PMID: 33835936 PMCID: PMC8122286 DOI: 10.2196/27308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Borderline personality disorder is a debilitating and prevalent mental health disorder, with often inaccessible treatment options. Electronically delivered dialectical behavioral therapy could be an efficacious and more accessible intervention. OBJECTIVE We aimed to evaluate the efficacy of electronic delivery of dialectical behavioral therapy in the treatment of individuals with symptoms of borderline personality disorder. METHODS Study participants diagnosed with borderline personality disorder were offered either an email-based or in-person group format dialectical behavioral therapy skill-building program. During each session, participants were provided with both the material and feedback regarding their previous week's homework. Electronically delivered dialectical behavioral therapy protocol and content were designed to mirror in-person content. Participants were assessed using the Self-Assessment Questionnaire (SAQ) and Difficulties in Emotion Regulation Scale (DERS). RESULTS There were significant increases in SAQ scores from pre- to posttreatment in the electronic delivery group (F1,92=69.32, P<.001) and in-person group (F1,92=60.97, P<.001). There were no significant differences observed between the groups at pre- and posttreatment for SAQ scores (F1,92=.05, P=.83). There were significant decreases in DERS scores observed between pre- and posttreatment in the electronic delivery group (F1,91=30.15, P<.001) and the in-person group (F1,91=58.18, P<.001). There were no significant differences observed between the groups for DERS scores pre- and posttreatment (F1,91=.24, P=.63). There was no significant difference in treatment efficacy observed between the 2 treatment arms (P<.001). CONCLUSIONS Despite the proven efficacy of in-person dialectical behavioral therapy in the treatment of borderline personality disorder, there are barriers to receiving this treatment. With the prevalence of internet access continuing to rise globally, delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care. TRIAL REGISTRATION ClinicalTrials.gov NCT04493580; https://clinicaltrials.gov/ct2/show/NCT04493580.
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Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Margo Rivera
- Personality Disorder Services, Queen's University, Kingston, ON, Canada
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