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Maulana I, Suryani S, Sriati A, Yosep I, Amira I, Hendrawati. "Empowering Hope: Non-Pharmacological Interventions for Borderline Personality Disorder (BPD) Communities": Scoping Review. J Multidiscip Healthc 2024; 17:4603-4609. [PMID: 39381418 PMCID: PMC11460281 DOI: 10.2147/jmdh.s483930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 09/24/2024] [Indexed: 10/10/2024] Open
Abstract
Aim Borderline personality disorder (BPD) is defined by impulsive behaviour and instability in interpersonal relationships, self-image, mood, and emotions. BPD can be prevented and treated using a mix of medication and psychotherapy. Non-pharmacological interventions are essential for maintaining stable interpersonal interactions in individuals with BPD. Goal The literature review tries to identify different methods of non-pharmacological management. Psychotherapy, particularly tailored to aid in the recovery from emotional disorders in individuals with BPD. The methodology employed is a scoping review that integrates papers from Semantic Scholars, Pubmed, and CINAHL databases. The keyword utilised is PICO. Outcomes Four pieces of literature aligned with the research goals based on the literature review results. Three articles discuss therapies that focus on cognitive processes, such as mindfulness therapy, schema therapy, Dialectical Behavioural Therapy (DBT), and therapy groups that incorporate supplementing with Omega-3. Conclusion Non-pharmacological therapies for patients with Borderline Personality Disorder (BPD) can enhance good psychosocial outcomes, dialectical effects, and decrease emotional instability.
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Affiliation(s)
- Indra Maulana
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Suryani Suryani
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Aat Sriati
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Iyus Yosep
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Iceu Amira
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Hendrawati
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Schmidt C, Soler J, Vega D, Nicolaou S, Arias L, Pascual JC. How does mindfulness skills training work to improve emotion dysregulation in borderline personality disorder? Borderline Personal Disord Emot Dysregul 2024; 11:22. [PMID: 39218933 PMCID: PMC11367780 DOI: 10.1186/s40479-024-00265-0] [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: 02/21/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Mindfulness skills training is a core component of Dialectical Behavior Therapy and aims to improve emotion dysregulation (ED) in people with Borderline Personality Disorder (BPD). However, the underlying mechanisms of change are not fully understood. METHODS A total of 75 BPD outpatients participated in a 10-week mindfulness skills training. Multilevel models with a time-lagged approach were conducted to examine the temporal dynamics between the proposed mechanisms and ED. Decentering, nonjudgment, body awareness and attention awareness as putative mechanisms and ED as outcome were assessed on a session-by-session basis. RESULTS Greater nonjudgment and body awareness showed within-person effects; participants who reported higher nonjudgement of inner experience and body awareness than their own personal average at a given week showed improvement in ED at the following week. Notably, decentering moderated these associations, such that increased nonjudgment and body awareness predicted improvements in ED more strongly in those participants with high decentering ability. Lastly, a bidirectional relationship between the mechanisms and ED was found; when participants were more emotionally dysregulated than their usual state, they showed less gain in the mechanisms at the following week. CONCLUSIONS Knowing how mindfulness training works is relevant to optimize treatments. Clinicians may use strategies to increase these mechanisms when the goal is to improve emotion regulation difficulties in BPD.
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Affiliation(s)
- Carlos Schmidt
- Brain, Cognition and Behavior PhD Program, University of Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.
| | - Daniel Vega
- Department of Psychiatry, Hospital Universitari d'Igualada (Consorci Sanitari de L'Anoia), Fundació Sanitària d'Igualada, Barcelona, Spain
| | - Stella Nicolaou
- Department of Psychiatry, Hospital Universitari d'Igualada (Consorci Sanitari de L'Anoia), Fundació Sanitària d'Igualada, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, Institute of Neurosciences (UBneuro), University of Barcelona, Barcelona, Spain
| | - Laia Arias
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Juan C Pascual
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
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Haeyen S, Dimaggio G. Arts and psychomotor therapies in the treatment of personality disorders. J Clin Psychol 2024; 80:1717-1725. [PMID: 38662958 DOI: 10.1002/jclp.23693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Suzanne Haeyen
- Department Health & Vitality, Research Group Arts & Psychomotor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, GL, The Netherlands
- GGNet, Centre for Mental Health, Scelta, Expert Centre for Personality Disorders Apeldoorn, Warnsveld, The Netherlands
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Morin A, Grondin S. Mindfulness and time perception: A systematic integrative review. Neurosci Biobehav Rev 2024; 162:105657. [PMID: 38583653 DOI: 10.1016/j.neubiorev.2024.105657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Several recent studies have explored the relationships between mindfulness and time perception, an area of research that has become increasingly popular in the last 10-15 years. In this article, we present a systematic integrative review of the evidence on this subject. We also integrate the field's findings into a conceptual framework which considers the multifaceted nature of both mindfulness, and time perception research. To identify the relevant literature, we searched the following databases using relevant keywords: PsycINFO; Medline; EBSCO Host Psychology and Behavioral Sciences Collection; and Web of Science. These searches were last performed on the 4th of May 2022, and additional hand searches were also conducted. To be included, articles had to be in English and contain original data about the potential relationship(s) between mindfulness and time perception. Articles which did not present usable data about the relationship(s) between the variables of interest were excluded. In total, 47 research articles were included in the review (combined sample size of ∼5800 participants). Risks of bias in the selected studies were evaluated using two separate assessment tools designed for this purpose. Through an integrative narrative synthesis, this article reviews how mindfulness may relate to time perception for various reference frames, and for various time perception measures and methods. It also provides new insights by exploring how a wide range of findings can be integrated into a coherent whole, in light of some relevant time perception models and mindfulness theories. Altogether, the reviewed data suggest the existence of complex and multifaceted relationships between mindfulness and time perception, highlighting the importance of considering many factors when planning research or interpreting data in this field. Limitations of the current review include the scarceness of data for certain categories of findings, and the relatively low prevalence of studies with a randomized controlled design in the source literature. This research was partly funded by a grant from the Natural Science and Engineering Research Council of Canada.
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Affiliation(s)
- André Morin
- École de psychologie, Université Laval, Québec, Canada.
| | - Simon Grondin
- École de psychologie, Université Laval, Québec, Canada
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Avila Chauvet L, Mejía Cruz D. Computational modeling of decision-making in substance abusers: testing Bechara's hypotheses. Front Psychol 2024; 15:1281082. [PMID: 38882514 PMCID: PMC11178135 DOI: 10.3389/fpsyg.2024.1281082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024] Open
Abstract
One of the cognitive abilities most affected by substance abuse is decision-making. Behavioral tasks such as the Iowa Gambling Task (IGT) provide a means to measure the learning process involved in decision-making. To comprehend this process, three hypotheses have emerged: (1) participants prioritize gains over losses, (2) they exhibit insensitivity to losses, and (3) the capacity of operational storage or working memory comes into play. A dynamic model was developed to examine these hypotheses, simulating sensitivity to gains and losses. The Linear Operator model served as the learning rule, wherein net gains depend on the ratio of gains to losses, weighted by the sensitivity to both. The study further proposes a comparison between the performance of simulated agents and that of substance abusers (n = 20) and control adults (n = 20). The findings indicate that as the memory factor increases, along with high sensitivity to losses and low sensitivity to gains, agents prefer advantageous alternatives, particularly those with a lower frequency of punishments. Conversely, when sensitivity to gains increases and the memory factor decreases, agents prefer disadvantageous alternatives, especially those that result in larger losses. Human participants confirmed the agents' performance, particularly when contrasting optimal and sub-optimal outcomes. In conclusion, we emphasize the importance of evaluating the parameters of the linear operator model across diverse clinical and community samples.
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Affiliation(s)
| | - Diana Mejía Cruz
- Psychology Department, Sonora Institute of Technology, Obregon City, Sonora, Mexico
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Traynor JM, McMain S, Chapman AL, Kuo J, Labrish C, Ruocco AC. Pretreatment cognitive performance is associated with differential self-harm outcomes in 6 v. 12-months of dialectical behavior therapy for borderline personality disorder. Psychol Med 2024; 54:1350-1360. [PMID: 37997387 DOI: 10.1017/s0033291723003197] [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: 11/25/2023]
Abstract
BACKGROUND Recent findings suggest that brief dialectical behavior therapy (DBT) for borderline personality disorder is effective for reducing self-harm, but it remains unknown which patients are likely to improve in brief v. 12 months of DBT. Research is needed to identify patient characteristics that moderate outcomes. Here, we characterized changes in cognition across brief DBT (DBT-6) v. a standard 12-month course (DBT-12) and examined whether cognition predicted self-harm outcomes in each arm. METHODS In this secondary analysis of 240 participants in the FASTER study (NCT02387736), cognitive measures were administered at pre-treatment, after 6 months, and at 12 months. Self-harm was assessed from pre-treatment to 2-year follow-up. Multilevel models characterized changes in cognition across treatment. Generalized estimating equations examined whether pre-treatment cognitive performance predicted self-harm outcomes in each arm. RESULTS Cognitive performance improved in both arms after 6 months of treatment, with no between-arm differences at 12-months. Pre-treatment inhibitory control was associated with different self-harm outcomes in DBT-6 v. DBT-12. For participants with average inhibitory control, self-harm outcomes were significantly better when assigned to DBT-12, relative to DBT-6, at 9-18 months after initiating treatment. In contrast, participants with poor inhibitory control showed better self-harm outcomes when assigned to brief DBT-6 v. DBT-12, at 12-24 months after initiating treatment. CONCLUSIONS This work represents an initial step toward an improved understanding of patient profiles that are best suited to briefer v. standard 12 months of DBT, but observed effects should be replicated in a waitlist-controlled study to confirm that they were treatment-specific.
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Affiliation(s)
- Jenna M Traynor
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shelley McMain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Janice Kuo
- Department of Psychology, PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, USA
| | - Cathy Labrish
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony C Ruocco
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
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Natividad A, Huxley E, Townsend ML, Grenyer BFS, Pickard JA. What aspects of mindfulness and emotion regulation underpin self-harm in individuals with borderline personality disorder? J Ment Health 2024; 33:141-149. [PMID: 36916308 DOI: 10.1080/09638237.2023.2182425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/16/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Self-harm presents significant risk for individuals with borderline personality disorder (BPD). Both self-harm and BPD are associated with deficits in mindfulness and emotion dysregulation. Previous research suggests that thought suppression and emotional inexpressivity may underpin self-harm in people with BPD, suggesting potential links to self-harm functions common for those with BPD. More research is needed to strengthen our understanding of this relationship. AIMS This study examines how BPD symptoms, mindfulness, emotion dysregulation and self-harm functions are related. METHODS Australian community outpatients diagnosed with BPD (N = 110) completed measures of mindfulness, emotion dysregulation and self-harm functions. Serial mediation analyses were conducted to examine relationships between variables. RESULTS BPD symptoms, chronic emptiness, mindfulness skills, describing and non-reacting, emotion dysregulation areas of emotion regulation strategies and poor emotional clarity were associated with recent self-harm. Various combinations of describing, strategies and clarity mediated the path between emptiness and self-harm functions more likely to be endorsed by individuals with a diagnosis of BPD. Describing was associated with all but anti-suicide function, while strategies was associated with all but anti-dissociation. CONCLUSION The study highlights how individuals with BPD experiencing chronic emptiness may benefit from treatment targeting describing skills and adaptive emotion regulation strategies.
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Affiliation(s)
- Ana Natividad
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Elizabeth Huxley
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Judy A Pickard
- School of Psychology, University of Wollongong, Wollongong, Australia
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Chmiel J, Malinowska A, Rybakowski F, Leszek J. The Effectiveness of Mindfulness in the Treatment of Methamphetamine Addiction Symptoms: Does Neuroplasticity Play a Role? Brain Sci 2024; 14:320. [PMID: 38671972 PMCID: PMC11047954 DOI: 10.3390/brainsci14040320] [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: 03/09/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Methamphetamine is a highly stimulating psychoactive drug that causes life-threatening addictions and affects millions of people around the world. Its effects on the brain are complex and include disturbances in the neurotransmitter systems and neurotoxicity. There are several known treatment methods, but their effectiveness is moderate. It must be emphasised that no drugs have been approved for treatment. For this reason, there is an urgent need to develop new, effective, and safe treatments for methamphetamine. One of the potential treatments is mindfulness meditation. In recent years, this technique has been researched extensively in the context of many neurological and psychiatric disorders. METHODS This review explores the use of mindfulness in the treatment of methamphetamine addiction. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS Ten studies were identified that used mindfulness-based interventions in the treatment of methamphetamine addiction. The results show that mindfulness is an effective form of reducing hunger, risk of relapses, stress indicators, depression, and aggression, alone or in combination with transcranial direct current stimulation (tDCS). Mindfulness also improved the cognitive function in addicts. The included studies used only behavioural measures. The potential mechanisms of mindfulness in addiction were explained, and it was proposed that it can induce neuroplasticity, alleviating the symptoms of addiction. CONCLUSIONS Evidence from the studies suggest that mindfulness may be an effective treatment option for methamphetamine addiction, used alone or in combination with tDCS. However, further high-quality research is required to establish the role of this treatment option in this field. The use of neuroimaging and neurophysiological measures is fundamental to understand the mechanisms of mindfulness.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | | | - Filip Rybakowski
- Department and Clinic of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Badia-Aguarón T, Royuela-Colomer E, Pera-Guardiola V, Vergés-Balasch P, Cebolla A, Luciano JV, Soler J, Feliu-Soler A, Huguet Miguel A. Combining mindfulness and cognitive training in children with attention deficit hyperactivity disorder: study protocol of a pilot randomized controlled trial (the NeuroMind study). Front Psychol 2024; 15:1291198. [PMID: 38384348 PMCID: PMC10879620 DOI: 10.3389/fpsyg.2024.1291198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) has a global mean prevalence of 5%. Cognitive Training (CT) and Mindfulness-Based Interventions (MBIs) have shown promising results in managing ADHD symptoms, but they are not its Treatment-As-Usual (TAU). The NeuroMind Study aims to evaluate the preliminary effectiveness and feasibility of three interventions: Mindfulness for Health (M4H), CT using the NeuronUP® platform (CT), and a combination of both, Mindfulness Cognitive Training (MCT). There is empirical evidence supporting the effectiveness of the M4H and NeuronUP® platform; however, this study explores for the first time the effectiveness of MCT and CT, as well as the integration of M4H into TAU. The objectives of this 5-month Randomized Controlled Trial (RCT) are: (1) To analyze the preliminary effectiveness and feasibility of M4H, CT or a combination of both (MCT) added to TAU for children with ADHD; (2) To evaluate the role of psychological process variables (mindfulness and emotional regulation) as mediators of 5-month follow-up clinical outcomes; (3) To preliminarily explore whether specific sociodemographic and clinical characteristics can predict the short-and medium-term clinical response to the specific treatments. Methods and analysis Participants will be 120 children (7 to 12 years) with ADHD recruited at Child and Adolescent Mental Health Service (CAMHS) Sant Joan de Déu Terres de Lleida (Spain) randomly allocated to one of the four study arms: TAU vs. TAU + CT vs. TAU + M4H vs. TAU + MCT. An assessment to collect ADHD symptoms, Executive Functions (EF), comorbid symptoms and global functioning will be conducted pre-intervention, post-intervention (2 months after baseline) and at the 5-month follow-up. Linear mixed models and mediational models will be computed. Discussion If the preliminary effectiveness and feasibility of the MCT are demonstrated, this study could be a preliminary basis to do a full RCT with a larger sample to definitively validate the intervention. The MCT could be applied in clinical practice if it is definitively validated.Clinical trial registration:ClinicalTrials.gov, identifier, NCT05937347. https://clinicaltrials.gov/study/NCT05937347?locStr=Spain&country=Spain&cond=ADHD&intr=Mindfulness&rank=1.
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Affiliation(s)
- Tania Badia-Aguarón
- Department of Basic, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Estíbaliz Royuela-Colomer
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Vanessa Pera-Guardiola
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
- Department of Psychology, University of Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Pere Vergés-Balasch
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
| | - Ausiàs Cebolla
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Juan V. Luciano
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquim Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
- CIBER of Mental Health (CIBERSAM), Madrid, Spain
| | - Albert Feliu-Soler
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Huguet Miguel
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
- Sant Joan de Déu Research Institute (IRSJD), Esplugues de Llobregat, Spain
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Vijayapriya CV, Tamarana R. Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:694. [PMID: 37905964 PMCID: PMC10690726 DOI: 10.4081/ripppo.2023.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023]
Abstract
Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.
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Han J, Allison S, Looi JCL, Chan SKW, Bastiampillai T. A systematic review of the role of clozapine for severe borderline personality disorder. Psychopharmacology (Berl) 2023; 240:2015-2031. [PMID: 37572113 PMCID: PMC10506937 DOI: 10.1007/s00213-023-06431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
RATIONALE Clozapine is a unique medication with a potential role in the treatment of severe borderline personality disorder (BPD). OBJECTIVES The review examines the effectiveness of clozapine as a medication for management for severe BPD with high risk of suicide, violence or imprisonment, and aims to help guide clinical practice in managing severe BPD. METHODS A database search of the terms "Clozapine" AND "BPD"; "Antipsychotics" AND "BPD"; "Clozapine" AND "Borderline Personality Disorder"; and "Antipsychotics" AND "Borderline Personality Disorder" were performed in CINAHL, Cochrane Library, Embase, Medline, PsychINFO, PubMed, and Web of Science. Full-text articles of clinical clozapine use for BPD were included for review. RESULTS A total of 24 articles consisting of 1 randomised control trial, 10 non-controlled trials, and 13 case reports were identified. Most of the studies reported benefits from clozapine when used for severe BPD. Many of the studies focused on clozapine use in BPD patients at high risk of suicide. Results from these non-controlled and case reports support the use of clozapine in patients with severe BPD at high risk of suicide. CONCLUSION There may be a role for clozapine in treating severe treatment refractory BPD, especially for those patients at high risk of suicide and frequent hospitalisations.
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Affiliation(s)
- Joshua Han
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Stephen Allison
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Consortrium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), ACT, Canberra, Australia
| | - Jeffrey C L Looi
- Consortrium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), ACT, Canberra, Australia
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Sherry Kit Wa Chan
- Department of Psychiatry, the School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Psychiatry, Monash University, Wellington Road, Clayton, Victoria, Australia
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Vijayapriya CV, Tamarana R. Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: a systematic review. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:662. [PMID: 37401476 PMCID: PMC10481423 DOI: 10.4081/ripppo.2023.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/14/2023] [Indexed: 07/05/2023]
Abstract
Dialectical behavior therapy (DBT) has been found to be an efficacious treatment for disorders characterized by high levels of emotional instability. In view of the multifaceted applications of DBT and the extent to which mental disorders can incapacitate cognitive functions, the current systematic review aimed to investigate the effect of DBT in strengthening cognitive functions across various mental health conditions. Original research studies employing both experimental and quasi-experimental designs were included in the review. The literature search was done using different electronic databases, from the first available literature until June 2022, that covered an approximate period of ten years. Joanna Briggs Institute checklist was used to assess the methodological rigor of the studies. Twelve studies conducted on adolescents with emotional dysregulation, and adults with borderline personality disorder, bipolar disorder, attention deficit hyperactivity disorder, and multiple sclerosis were selected. Results indicate that DBT has the potential to improve key cognitive functions such as attention, memory, fluency, response inhibition, planning, set shifting, tolerance for delayed rewards and time perception, as assessed by neuropsychological tests, self-report of cognitive functions, and neuroimaging techniques. Considering the review's findings that showcase the effectiveness of DBT in fostering improvements in cognitive functions, DBT may possibly be chosen as a preferred treatment to ensure that patients reach optimal levels of cognitive functioning. Limitations include lack of sufficient studies encompassing all the common mental health conditions, usage of neuroimaging techniques as only an indirect measure of cognitive functioning and nuances related to the quality of individual studies.
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Schmidt P. On Experiential Loneliness. TOPOI : AN INTERNATIONAL REVIEW OF PHILOSOPHY 2023:1-16. [PMID: 37361722 PMCID: PMC10262127 DOI: 10.1007/s11245-023-09936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
Presumably, everyone has, at some point in their lives, felt lonely. Loneliness is, in that particular sense, omnipresent. What it feels like to be lonely can, however, vary significantly. Loneliness is far from being a homogeneous phenomenon. Different kinds of loneliness need to be distinguished, considering its causes, contexts, a person's capacities to cope with it, and many other factors. This paper introduces the notion of a specific kind of loneliness: experiential loneliness. Experiential loneliness, it will be argued, consists in particular ways of experiencing the world, oneself, and others. Although feelings of being lonely in one way or another can emanate from one's experience of the world being structured in a particular manner, such kinds of loneliness need not-at least, not always and the whole time-lead to emotional feelings that are concerned with one's loneliness or the lack of meaningful social relationship. Loneliness can give rise to quite different emotional feelings that sometimes even cover up their provenience from underlying experiential loneliness. The notion of experiential loneliness, it is suggested, helps to tie back certain styles of thinking, desires, feelings, and behaviors to contexts of loneliness. Moreover, it will be argued that the notion can also elucidate the development of feelings of being lonely in contexts in which others are not only around but also available. To develop and enrich the notion of experiential loneliness as well as to exemplify its usefulness, a closer look will be taken at the case of borderline personality disorder, a condition in which sufferers are often plagued by loneliness.
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Affiliation(s)
- Philipp Schmidt
- Institut für Philosophie, Julius-Maximilians-Universität Würzburg, Ehrenhof Südflügel, Residenzplatz 2, 97070 Würzburg, Germany
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Roberts A, de Visser R, Rosten C, Startup H, Strauss C. Does trait mindfulness mediate the relationship between borderline personality symptoms and emotion dysregulation? Borderline Personal Disord Emot Dysregul 2023; 10:19. [PMID: 37287075 DOI: 10.1186/s40479-023-00225-0] [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: 02/10/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Emotion dysregulation is core to many biopsychosocial models of Borderline Personality Disorder (BPD) and is often targeted as part of their associated psychological therapies. Several distinct specialist psychotherapies are thought to be effective for people diagnosed with BPD but it is unclear whether they share common change mechanisms. Some evidence suggests that Mindfulness Based Interventions improve competency in emotion regulation as well as trait mindfulness, which are both plausibly associated with good treatment outcomes. It is unclear whether the association between the severity of BPD symptoms and emotion dysregulation is mediated by trait mindfulness. Would improvement in trait mindfulness mediate an association between lower severity of BPD symptoms and fewer problems of emotion dysregulation? METHODS One thousand and twelve participants completed online, single time-point, self-report questionnaires. RESULTS As predicted, the severity of BPD symptoms was significantly and positively associated with emotion dysregulation with a large effect size (r = .77). Trait mindfulness mediated this relationship as the 95% confidence interval for the indirect effect did not cross zero (size of direct effect = .48 and size of indirect effect = .29 [.25, .33]. CONCLUSIONS The relationship between the severity of BPD symptoms and emotion dysregulation was confirmed in this dataset. As hypothesised, this relationship was mediated by trait mindfulness. Process measures of emotion dysregulation and mindfulness should be included in intervention studies for people diagnosed with BPD to understand if improvements in these factors are a universal occurrence with good response to treatment. Other process measures should also be explored to identify other factors involved in the relationship between BPD symptoms and emotion dysregulation.
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Affiliation(s)
- Alison Roberts
- University of Sussex, Brighton and Hove, UK.
- Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK.
| | | | | | - Helen Startup
- University of Sussex, Brighton and Hove, UK
- Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK
| | - Clara Strauss
- University of Sussex, Brighton and Hove, UK
- Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK
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Setkowski K, Palantza C, van Ballegooijen W, Gilissen R, Oud M, Cristea IA, Noma H, Furukawa TA, Arntz A, van Balkom AJLM, Cuijpers P. Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychol Med 2023; 53:3261-3280. [PMID: 37203447 PMCID: PMC10277776 DOI: 10.1017/s0033291723000685] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Christina Palantza
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Matthijs Oud
- Department of Treatment, Care and Reintegration, Trimbos Institute, Utrecht, the Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Bud S, Nechita D, Szentagotai Tatar A. Emotion regulation strategies in borderline personality disorder: a meta-analysis. CLIN PSYCHOL-UK 2023. [DOI: 10.1080/13284207.2022.2152668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Samuel Bud
- Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Diana Nechita
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Aurora Szentagotai Tatar
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
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Reitano MR, Guidetti M, Maiorana NV, De Sandi A, Carusi F, Rosci C, Ruggiero F, Poletti B, Ticozzi N, Mameli F, Barbieri S, Silani V, Priori A, Ferrucci R. The Effects of a New Integrated and Multidisciplinary Cognitive Rehabilitation Program Based on Mindfulness and Reminiscence Therapy in Patients with Parkinson's Disease and Mild Cognitive Impairment: A Pilot Study. Brain Sci 2023; 13:201. [PMID: 36831744 PMCID: PMC9954653 DOI: 10.3390/brainsci13020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Background: Mindfulness trainings have shown promising results as treatment for behavioural symptoms in several pathologies. In addition, mindfulness protocols induced an improvement in memory and attention. Therefore, mindfulness could be an effective intervention for patients affected by Parkinson's disease (PD) and mild cognitive impairment (MCI), who are characterized by both behavioural and cognitive dysfunctions. Methods: We assessed differences in Montreal Cognitive Assessment (MoCA) scores and in Beck Depression Inventory II (BDI-II) scores in patients affected by PD and MCI enrolled in two different rehabilitation programs (an experimental vs. an usual structured program for cognitive rehabilitation). Participants in the experimental group (MILC-tr) underwent innovative rehabilitation program involving mindfulness and reminiscence activities. Assessments were performed before (T0) and at the end of the rehabilitation program (T1). Results: Friedman test showed a significant improvement between timepoints in MoCA global score (x2 = 4.000, p = 0.046), MoCA memory sub-scale score (x2 = 4.571, p = 0.033), and BDI-II cognitive and affective factors (x2 = 4.000, p = 0.046) only for patients in MILC-tr group. Mann-Whitney test showed a significant difference between group comparing differences in Δ scores between T0 and T1 in the MoCA memory sub-scale score (U = 190.50, p = 0.035). Conclusions: Mindfulness-based rehabilitation programs could be effective in patients affected by PD and MCI.
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Affiliation(s)
- Maria Rita Reitano
- ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milan, Italy
| | - Matteo Guidetti
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Natale Vincenzo Maiorana
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Angelica De Sandi
- ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milan, Italy
| | - Fabrizio Carusi
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Chiara Rosci
- ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milan, Italy
| | - Fabiana Ruggiero
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
| | - Francesca Mameli
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sergio Barbieri
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, 20122 Milan, Italy
| | - Alberto Priori
- ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milan, Italy
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Roberta Ferrucci
- ASST Santi Paolo e Carlo, San Paolo University Hospital, 20142 Milan, Italy
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
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Soler J, Casellas-Pujol E, Pascual JC, Schmidt C, Domínguez-Clavé E, Cebolla A, Alvear D, Muro A, Elices M. Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention. Borderline Personal Disord Emot Dysregul 2022; 9:34. [PMID: 36503564 PMCID: PMC9743724 DOI: 10.1186/s40479-022-00204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Long-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. METHODS This 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. RESULTS The 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%. CONCLUSIONS The 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.
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Affiliation(s)
- Joaquim Soler
- 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
| | - Elisabet Casellas-Pujol
- 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
| | - Juan Carlos Pascual
- 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.
| | - Carlos Schmidt
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Elisabet Domínguez-Clavé
- 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
| | - Ausias Cebolla
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, University of Valencia UV, Valencia, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - David Alvear
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, leioa, Spain
| | - Anna Muro
- 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
| | - Matilde Elices
- 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
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Study protocol for a multi-center RCT testing a group-based parenting intervention tailored to mothers with borderline personality disorder against a waiting control group (ProChild*-SP1). Trials 2022; 23:589. [PMID: 35870944 PMCID: PMC9308114 DOI: 10.1186/s13063-022-06531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background/aims
Borderline personality disorder (BPD) is a severe mental disorder characterized by an unstable sense of self, intense and rapidly changing affect, as well as impulsive and self-destructive behaviors. Interpersonal relationships of individuals with BPD are characterized by marked instability, a lack of dependability, and quick changes between love and hate. For children of individuals with BPD, this can lead to permanent stress and attachment insecurity and an increased risk of adverse physical and mental health development. To reduce dysfunctional parenting and improve positive parenting, and in turn, to promote healthy child development, a group intervention for mothers with BPD was developed. This study aims to evaluate this first disorder-specific parenting intervention for BPD in a randomized controlled trial. Method In a parallel-group, two-arm, randomized controlled trial, an initial N = 178 mothers diagnosed with BPD and their children aged 6 months to 6 years are assigned to either the parenting intervention or a waiting control group. If taking place, participants of both groups continue their regular treatment for BPD diagnosis (e.g., individual therapy, medication). The primary outcomes are changes in parenting from baseline (day 0) to post intervention (week 12) and follow-up (6 months after group intervention; month 9). The waiting control group can attend the group intervention at the end of all assessments. Participants allocated to the intervention group are expected to show improvement in their parenting and a reduction in child abuse potential. Maternal emotion regulation and mental distress are analyzed as secondary outcomes. Discussion Mothers with BPD may need tailored help when reporting difficulties raising their children. The first disorder-specific parenting intervention has been developed to close this gap. ProChild is part of a large government-supported consortium, which aims to investigate different aspects of abuse and maltreatment in childhood and adolescence. Trial registration ClinicalTrials.gov NCT04169048. Registered on Nov 19, 2019.
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20
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Yao N, Wei Z, Wang Y, Sun L. Associations between Drinking Behaviors and Meaning in Life: Evidence from Primary Care Professionals in China. Nutrients 2022; 14:nu14224811. [PMID: 36432499 PMCID: PMC9694648 DOI: 10.3390/nu14224811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Although the associations between drinking behaviors and emotional problems have been supported in several previous studies, the associations between drinking behaviors and meaning in life have not been explored until now. We aimed to test the associations between drinking behaviors and meaning in life among primary care professionals, after controlling for depression. (2) Methods: In the current study, we collected 1453 valid questionnaires based on a cross-sectional design. Meaning in life, drinking behaviors, physical diseases, depression, work-related variables, and some other social-demographic variables were evaluated. (3) Results: The results support that after controlling for depression, regular milk drinking (β = 1.387, p = 0.026), and regular juice drinking (β = 2.316, p = 0.030) were associated with higher meaning in life, while regular water drinking (β = −1.448, p = 0.019) was negatively associated with meaning in life. In addition to this, the results showed that the older age (β = 0.098, p = 0.001), preventive medicine majors (β = 4.281, p = 0.013), working fewer days per week (β = −0.942, p = 0.004), licensed (assistant) technician qualification (β = 2.921, p = 0.036), and no depression (β = −0.203, p < 0.001) were positively associated with meaning in life. (4) Conclusion: This study supported the association between drinking behaviors and meaning in life, even after controlling depression. These findings imply that we can further explore this association and its mechanisms in future studies.
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Affiliation(s)
- Nan Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Zhen Wei
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Yifan Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Correspondence:
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Martin S, Del‐Monte J. Just try it: Preliminary results of a six-month therapy for borderline personality disorder. Personal Ment Health 2022; 16:338-349. [PMID: 35751447 PMCID: PMC9787760 DOI: 10.1002/pmh.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
Borderline Personality Disorder (BPD) is labeled as a personality disorder with impulsivity issues regarding relationships, risky behavior, and emotional dysregulation. This personality disorder is still considered to be hard-to-treat condition even though responses to treatment have improved significantly. In this field, Dialectical Behavioral Therapy is recognized as one of the most efficient therapeutical approaches, and some versions adapted from this gold-standard treatment proved their effectiveness in clinical settings. We tested the 6-month cognitive behavioral therapy (CBT) protocol ECCCLORE, composed of three modules, respectively, working on emotional regulation, distress tolerance, and relationships-in a French context to compare its effectiveness to Treatment As Usual. We recruited 56 patients with a BPD diagnosis in a day-care unit, 34 receiving ECCCLORE and 22 receiving TAU. We assessed BPD traits, impulsivity, aggressiveness, suicidal risk, and hopelessness. Our results revealed the effectiveness of the 6-month ECCCLORE protocol to decrease BPD symptoms and associated clinical dimensions. We also noted the persistence of its effect after a 1-year follow-up. Shortened CBT treatment protocols tend to prove their efficiency for symptom reduction in BPD. Further research is needed to replicate these results.
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Affiliation(s)
- Sylvia Martin
- Center for Research and BioethicsUppsala UniversityUppsalaSweden
- Psycho‐TCCEPrivate PracticeNîmesFrance
| | - Jonathan Del‐Monte
- Center for Research and BioethicsUppsala UniversityUppsalaSweden
- Psycho‐TCCEPrivate PracticeNîmesFrance
- Clinical Psychology DepartmentNîmes UniversityNîmesFrance
- LPS laboratoryAix‐Marseille UniversityAix‐en‐ProvenceFrance
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22
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Shaker NM, Azzam LA, Zahran RM, Hashem RE. Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity. Eat Weight Disord 2022; 27:2497-2506. [PMID: 35301691 DOI: 10.1007/s40519-022-01358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation. METHOD Seventy participants aged 25.81 ± 6.34 years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale. RESULTS All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated. CONCLUSION A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Nermin Mahmoud Shaker
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Lobna AbuBakr Azzam
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Randa Mohamad Zahran
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Reem Elsayed Hashem
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt.
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Kerr S, Penner F, Ilagan G, Choi-Kain L, Sharp C. Maternal interpersonal problems and attachment security in adolescent offspring. Borderline Personal Disord Emot Dysregul 2022; 9:18. [PMID: 35773724 PMCID: PMC9248194 DOI: 10.1186/s40479-022-00188-8] [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: 02/10/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on parent-level factors linked to adolescent attachment security would inform interventions to prevent or reduce youth psychopathology and other negative outcomes. The current study examined one relevant parent-level variable: maternal interpersonal problems. Interpersonal problems, a key characteristic of personality pathology, are well described by the interpersonal circumplex (IPC) and have been shown to be associated with maladaptive adult attachment in close/romantic relationships; however, studies have not examined relationships with offspring attachment. Therefore, the first aim of the current study was to examine the relationship between maternal interpersonal problems and adolescent attachment insecurity. Based on previous evidence that parents' recalled bonding with caregivers is associated with the quality of bonding and attachment with offspring, the second aim was to examine whether mothers' recalled bonding with their own mothers partially explained this relationship. METHODS Participants included 351 psychiatric inpatient adolescents (Mage = 15.26, 64.1% female) and their biological mothers. Logistic regressions tested whether maternal interpersonal problems were associated with Child Attachment Interview classifications (secure vs. insecure; secure vs. preoccupied vs. dismissing; not disorganized vs. disorganized). A mediation model (N = 210) tested whether the relationship between maternal interpersonal problems and adolescent attachment was mediated by the mother's recalled maternal bonding. RESULTS Maternal interpersonal problems were associated with insecure (vs. secure), dismissing (vs. secure), and preoccupied (vs. secure) attachment. There was no significant relationship between maternal interpersonal problems and disorganized attachment. Mediation analyses showed that maternal interpersonal problems were indirectly related to adolescent attachment security via the mother's recalled maternal care, though only a small amount of variance (7%) in adolescent offspring attachment was accounted for by the model. CONCLUSIONS Results provide the first evidence that maternal interpersonal problems are associated with higher likelihood of insecure attachment in adolescents. Therefore, researchers could consider drawing upon the IPC literature to further examine mechanisms of intergenerational risk and to tailor interventions aimed to improve parent-child relations and attachment. Additionally, findings highlight the mediating role of the mothers' recalled experiences with caregivers in the transmission of risk, suggesting attachment-based or mentalization-based interventions may be helpful for mothers with interpersonal problems and personality pathology.
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Affiliation(s)
- Sophie Kerr
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Room, Houston, TX, 126, USA
| | - Francesca Penner
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Room, Houston, TX, 126, USA
- Child Study Center, Yale University, New Haven, CT, USA
| | | | - Lois Choi-Kain
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, 3695 Cullen Blvd, Room, Houston, TX, 126, USA.
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Eeles J, Walker DM. Mindfulness as taught in DBT: a scoping review. Clin Psychol Psychother 2022; 29:1843-1853. [PMID: 35726695 PMCID: PMC10084181 DOI: 10.1002/cpp.2764] [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: 01/07/2022] [Revised: 04/25/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
This scoping review considers Eleven studies that have focussed on the effect of teaching the mindfulness element of Dialectical Behaviour Therapy (DBT) on clinical outcomes. These articles utilised either mindfulness skills as embedded into the full DBT-Skills program or a stand-alone mindfulness skills module (DBT-M), as treatment for clinical populations. The review of the research found that clinical application of mindfulness as taught in DBT leads to increases in self-reported mindfulness - especially non-judgemental awareness along with psychological measures that suggests an increase in mindfulness e.g. improved attention. The studies demonstrated that an increase in mindfulness had a positive effect on some clinical symptoms such as symptoms of Borderline Personality Disorder. Not all of the studies controlled for the effect of group, amount of practice or other elements of DBT therapy. The findings suggest that more needs to be done to establish the underlying mechanisms of change when being taught mindfulness in DBT.
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Affiliation(s)
- Jennifer Eeles
- Faculty of Environmental and Health Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Dawn-Marie Walker
- Faculty of Environmental and Health Sciences, School of Health Sciences, University of Southampton, Southampton, UK
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25
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Haeyen S. Effects of Arts and Psychomotor Therapies in Personality Disorders. Developing a Treatment Guideline Based on a Systematic Review Using GRADE. Front Psychiatry 2022; 13:878866. [PMID: 35782411 PMCID: PMC9243752 DOI: 10.3389/fpsyt.2022.878866] [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: 02/18/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
What is the effect of arts and psychomotor therapies, using art, dance, drama, music, movement and body awareness, in personality disorder treatment? This was explored by developing a treatment guideline based on a systematic review using the GRADE system within the context of the Dutch national multidisciplinary guidelines for treatment of personality disorders. Conclusions were formulated by a work group and based on the scientific substantiation and were integrated with other indications in the functioning of arts and psychomotor therapies in personality disorders. The first general search yielded 1,900 records which was brought back to 53 full-texts. Ultimately, 1 RCT and 2 pilot studies were included. Recommendations for treatment are that arts and psychomotor therapies are included in treatment, independent of age, sex or specific diagnostic characteristics. Arts and psychomotor therapies can be considered for purposes of coming into emotional contact with difficult aspects of patients and their experiences, to work on goals such as regulation of emotions, stress, identity/self-image, self-expression, mood/anxiety, relaxation, changing patterns and social functioning. Enlisting arts and psychomotor therapies for patients with a personality disorder is recommended because they value these therapies and perceive these to be effective. It could be considered to ask arts and psychomotor therapies to provide a contribution to the diagnostic process, to the problem analysis via observation and to determining treatment indication and treatment goals. More research is needed.
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Affiliation(s)
- Suzanne Haeyen
- Department 'Scelta', Expert Center for Personality Disorders, GGNet Centre of Mental Health, Apeldoorn, Netherlands.,Special Research Group 'Arts and Psychomotor Therapies in Personality Disorders', HAN University of Applied Sciences, Nijmegen, Netherlands
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26
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Saini AK, Wal P, Wal A, Pal RS, Verma OP. A Narrative Review on Dialectical Behavior Therapy for Patients with Depressive Difficulties. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2021. [DOI: 10.2174/2666082218666211220153312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy (CBT) that was earlier intended to treat only patients with borderline personality disorder (BPD), but researchers have found DBT to treat several psychological disorders, including depression.
Aim:
The article aims to review the clinical shreds of evidence regarding the use of DBT to treat depression.
Methods:
PubMed literature search was done by applying the year filter range, 2010 to 2021. Another filter applied was "Randomized controlled trial", so that the strength of evidence could be enhanced. The keywords used were "Dialectical Behavior Therapy" AND "Depression
Results:
33 articles were found, out of which only 20 relevant articles were reviewed. DBT was found to alleviate depressive symptoms associated with different psychological disorders like bipolar disorder and BPD but the number of studies that validated the afore-mentioned were less than those studies which showed that DBT had no significant effect on the patients with depressive difficulties. The long-term effect of DBT for treating depression is under a suspect, as studies showed DBT got ineffective during the follow-ups
Conclusion:
DBT shows benefits in depression but further studies are still required to validate this concretely as DBT did not show a significant effect when compared to its control counterparts. There is much need for future studies which can evaluate the long-term efficacy of DBT in depression is another challenging area because follow-up data did not favor DBT.
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Affiliation(s)
- Aryendu Kumar Saini
- Department of Psychology, Indira Gandhi National Open University, Banaras Hindu University (B.H.U.) Regional Centre, Varanasi, India
| | - Pranay Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Ankita Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Rashmi Saxena Pal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
| | - Om Prakash Verma
- Department of Pharmacy, Pranveer Singh Institute of Technology, Kanpur, India
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27
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Schreuder MJ, Wigman JTW, Groen RN, Wichers M, Hartman CA. On the transience or stability of subthreshold psychopathology. Sci Rep 2021; 11:23306. [PMID: 34857821 PMCID: PMC8640053 DOI: 10.1038/s41598-021-02711-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/18/2021] [Indexed: 12/22/2022] Open
Abstract
Symptoms of psychopathology lie on a continuum ranging from mental health to psychiatric disorders. Although much research has focused on progression along this continuum, for most individuals, subthreshold symptoms do not escalate into full-blown disorders. This study investigated how the stability of psychopathological symptoms (attractor strength) varies across severity levels (homebase). Data were retrieved from the TRAILS TRANS-ID study, where 122 at-risk young adults (mean age 23.6 years old, 57% males) monitored their mental states daily for a period of six months (± 183 observations per participant). We estimated each individual's homebase and attractor strength using generalized additive mixed models. Regression analyses showed no association between homebases and attractor strengths (linear model: B = 0.02, p = 0.47, R2 < 0.01; polynomial model: B < 0.01, p = 0.61, R2 < 0.01). Sensitivity analyses where we (1) weighed estimates according to their uncertainty and (2) removed individuals with a DSM-5 diagnosis from the analyses did not change this finding. This suggests that stability is similar across severity levels, implying that subthreshold psychopathology may resemble a stable state rather than a transient intermediate between mental health and psychiatric disorder. Our study thus provides additional support for a dimensional view on psychopathology, which implies that symptoms differ in degree rather than kind.
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Affiliation(s)
- Marieke J Schreuder
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein, 19713 GZ, Groningen, The Netherlands.
| | - Johanna T W Wigman
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein, 19713 GZ, Groningen, The Netherlands
| | - Robin N Groen
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein, 19713 GZ, Groningen, The Netherlands
| | - Marieke Wichers
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein, 19713 GZ, Groningen, The Netherlands
| | - Catharina A Hartman
- Interdisciplinary Center for Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein, 19713 GZ, Groningen, The Netherlands
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28
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The Effect of Mindfulness-based Programs on Cognitive Function in Adults: A Systematic Review and Meta-analysis. Neuropsychol Rev 2021; 32:677-702. [PMID: 34350544 PMCID: PMC9381612 DOI: 10.1007/s11065-021-09519-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
Mindfulness-based programs (MBPs) are increasingly utilized to improve mental health. Interest in the putative effects of MBPs on cognitive function is also growing. This is the first meta-analysis of objective cognitive outcomes across multiple domains from randomized MBP studies of adults. Seven databases were systematically searched to January 2020. Fifty-six unique studies (n = 2,931) were included, of which 45 (n = 2,238) were synthesized using robust variance estimation meta-analysis. Meta-regression and subgroup analyses evaluated moderators. Pooling data across cognitive domains, the summary effect size for all studies favored MBPs over comparators and was small in magnitude (g = 0.15; [0.05, 0.24]). Across subgroup analyses of individual cognitive domains/subdomains, MBPs outperformed comparators for executive function (g = 0.15; [0.02, 0.27]) and working memory outcomes (g = 0.23; [0.11, 0.36]) only. Subgroup analyses identified significant effects for studies of non-clinical samples, as well as for adults aged over 60. Across all studies, MBPs outperformed inactive, but not active comparators. Limitations include the primarily unclear within-study risk of bias (only a minority of studies were considered low risk), and that statistical constraints rendered some p-values unreliable. Together, results partially corroborate the hypothesized link between mindfulness practices and cognitive performance. This review was registered with PROSPERO [CRD42018100904].
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29
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Wojciechowski T. The dual mediating roles of impulsivity and emotion regulation of the borderline personality disorder-violence relationship: A structural equation modeling approach. J Forensic Sci 2021; 66:2329-2339. [PMID: 34286852 DOI: 10.1111/1556-4029.14807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/28/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Although the past research has indicated that features of borderline personality disorder (BPD) increase the risk for violence, much less research has examined the mediators of this relationship. This study examined the mediating roles that impulsivity and emotion dysregulation may play in explaining the relationship between BPD and violence. The Pathways to Desistance data were used in analyses. Generalized structural equation modeling was used to estimate the direct effect of BPD features on violent offending risk and to examine the mediating roles of emotion dysregulation and impulsivity. Results indicated that the direct effect of BPD symptoms on violence was mediated to non-significance by key constructs, and the magnitude of the effect was reduced by around 40%. The total indirect effect was significant, and the mediation was attributed mainly to impulsivity. This indicates the importance of structuring treatment programming for BPD patients around impulsivity for reducing violence. Programming focused on improving impulsivity among individuals suffering from BPD may aid in reducing violent offending among this population, particularly those prior histories of involvement with the criminal justice system.
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Affiliation(s)
- Thomas Wojciechowski
- Michigan State University School of Criminal Justice, East Lansing, Michigan, USA
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30
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How could mindfulness-based intervention reduce aggression in adolescent? Mindfulness, emotion dysregulation and self-control as mediators. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01778-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Mungo A, Hein M, Hubain P, Loas G, Fontaine P. Impulsivity and its Therapeutic Management in Borderline Personality Disorder: a Systematic Review. Psychiatr Q 2020; 91:1333-1362. [PMID: 32989635 DOI: 10.1007/s11126-020-09845-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of remission but also suicide. The purpose of this review is to establish an inventory on the management of impulsivity in BPD and determine the effective treatments. A systematic review on the PubMed and Ovid databases was conducted up to September 2019 to December 2019 using the PRISMA guidelines. The inclusion criteria were: studies with patients with borderline personality disorder, were published between 1989 and 2019, used English-language and evaluated impulsivity before and after treatment. 41 articles selected were included for pharmacological treatment. 24 articles were found for psychotherapeutic management and one randomized study of transcranial magnetic stimulation. Based on this review, we must focus on psychotherapy in BPD, particularly the schema therapy, dialectical behavioral therapy, psychoeducation, system training of emotional predictability and problem solving and psychotherapy using mentalisation. The use of neuroleptics and mood stabilizers appears to be more effective than antidepressants. Another approach, such as transcranial magnetic stimulation, may prove useful in the near future if this technique is studied further.
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Affiliation(s)
- Anaïs Mungo
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium.
| | - Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium
| | - Philippe Fontaine
- Department of Psychiatry, CHC Liège - site Saint Vincent, Rocourt, Belgium
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32
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[New insights into diagnostics and therapy of personality disorders-Changes in ICD-11]. DER NERVENARZT 2020; 91:863-871. [PMID: 32542432 DOI: 10.1007/s00115-020-00936-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Personality disorders (PD) occur frequently and show high remission rates in the long term, while psychosocial recovery remains unsuccessful in a substantial proportion of cases. In ICD-11 the traditional view that PDs have a high stability is abandoned. Instead, the minimum duration is 2 years. The diagnostic process differentiates between three degrees of severity (mild, moderate, severe) and five prominent personality trait domains. Optionally, a borderline qualifying factor can be additionally codified. There is sufficient empirical evidence only for the treatment of borderline PD (BPD). Disorder-specific psychotherapy, in particular dialectic behavioral therapy (DBT) and mentalization-based therapy (MBT) have proven to be effective. Therapy modules targeting functional impairments and prominent personality trait domains could close the existing gaps in the disorder-specific treatment of PD.
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Abstract
Zusammenfassung
Hintergrund
Forschungsergebnisse weisen übereinstimmend darauf hin, dass Kinder von Müttern mit einer Borderline-Persönlichkeitsstörung (BPS) ein erhöhtes Risiko aufweisen, emotionale und verhaltensbezogene Auffälligkeiten zu entwickeln und/oder im Jugendalter selbst BPS-spezifische Symptomausprägungen zu zeigen.
Fragestellung
Welche Faktoren sind bei der familiären Transmission der BPS involviert, und welche Implikationen für die Praxis können darauf aufbauend abgeleitet werden?
Material und Methode
Auf der Basis einer umfassenden Literaturrecherche wurden aktuelle Forschungsbefunde zur familiären Transmission der BPS von Müttern zu ihren Kindern zusammengetragen und Kernbefunde in einem Transmissionsmodell integriert.
Ergebnisse
Das hier postulierte Transmissionsmodell bildet ein komplexes Zusammenspiel verschiedener Einflussfaktoren und Übertragungsmechanismen ab. Neben Faktoren aufseiten der Mutter und des Kindes werden externe Faktoren in das Modell integriert. Darüber hinaus werden (epi-)genetische und pränatale Einflüsse, die Bedeutung der Mutter-Kind-Interaktion und familiäre sowie soziale bzw. gesellschaftliche Einflüsse als Übertragungsmechanismen betont. Zudem wird eine potenziell präventive Wirkung der Hilfesysteme angenommen.
Schlussfolgerung
Aus dem Modell werden Ansatzpunkte abgeleitet, die dazu beitragen könnten, die Vulnerabilität sowie Belastungsfaktoren zu reduzieren und somit eine gesunde kindliche Entwicklung in dieser Risikogruppe zu fördern.
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Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, Faltinsen E, Todorovac A, Sales CP, Callesen HE, Lieb K, Simonsen E. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2020; 5:CD012955. [PMID: 32368793 PMCID: PMC7199382 DOI: 10.1002/14651858.cd012955.pub2] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers-Winterling 2012). OBJECTIVES To assess the beneficial and harmful effects of psychological therapies for people with BPD. SEARCH METHODS In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA Randomised controlled trials comparing different psychotherapeutic interventions with treatment-as-usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). The comparator interventions included treatment-as-usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months. Psychotherapy versus TAU Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.70 to -0.33; 22 trials, 1244 participants; moderate-quality evidence. This corresponds to a mean difference (MD) of -3.6 (95% CI -4.4 to -2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is -3.0 points). Psychotherapy may be more effective at reducing self-harm compared to TAU (SMD -0.32, 95% CI -0.49 to -0.14; 13 trials, 616 participants; low-quality evidence), corresponding to a MD of -0.82 (95% CI -1.25 to 0.35) on the Deliberate Self-Harm Inventory Scale (range 0 to 34). The MIREDIF of -1.25 points was not reached. Suicide-related outcomes improved compared to TAU (SMD -0.34, 95% CI -0.57 to -0.11; 13 trials, 666 participants; low-quality evidence), corresponding to a MD of -0.11 (95% CI -0.19 to -0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of -0.17 points was not reached. Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD -0.45, 95% CI -0.68 to -0.22; 22 trials, 1314 participants; low-quality evidence), corresponding to a MD of -2.8 (95% CI -4.25 to -1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of -4.0 points was not reached. Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases. A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning. Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD -0.39, 95% CI -0.61 to -0.17; 22 trials, 1568 participants; very low-quality evidence), corresponding to a MD of -2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of -3.0 points was not reached. BPD-specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data. Psychotherapy versus waiting list or no treatment Greater improvements in BPD symptom severity (SMD -0.49, 95% CI -0.93 to -0.05; 3 trials, 161 participants), psychosocial functioning (SMD -0.56, 95% CI -1.01 to -0.11; 5 trials, 219 participants), and depression (SMD -1.28, 95% CI -2.21 to -0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low-quality evidence). No evidence of a difference was found for self-harm and suicide-related outcomes. Individual treatment approaches DBT and MBT have the highest numbers of primary trials, with DBT as subject of one-third of all included trials, followed by MBT with seven RCTs. Compared to TAU, DBT was more effective at reducing BPD severity (SMD -0.60, 95% CI -1.05 to -0.14; 3 trials, 149 participants), self-harm (SMD -0.28, 95% CI -0.48 to -0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD -0.36, 95% CI -0.69 to -0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self-harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD -0.58, 95% CI -1.22 to 0.05, 4 trials, 333 participants). All findings are based on low-quality evidence. For secondary outcomes see review text. AUTHORS' CONCLUSIONS Our assessments showed beneficial effects on all primary outcomes in favour of BPD-tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF-defined cut-off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) . The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low-quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self-harm and suicide-related outcomes. However, compared to TAU, we observed effects in favour of DBT for BPD severity, self-harm and psychosocial functioning and, for MBT, on self-harm and suicidality at end of treatment, but these were all based on low-quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.
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Affiliation(s)
- Ole Jakob Storebø
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jessica T Mattivi
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mie S Jørgensen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Christian P Sales
- Duncan MacMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Institute of Mental Health, Department of Psychiatry & Applied Psychology, Nottingham, UK
| | | | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
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Keng SL, Lee CSL, Eisenlohr-Moul TA. Effects of brief daily mindfulness practice on affective outcomes and correlates in a high BPD trait sample. Psychiatry Res 2019; 280:112485. [PMID: 31408773 DOI: 10.1016/j.psychres.2019.112485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/14/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
Borderline personality disorder (BPD) is a psychological disorder characterized by dysregulation across multiple domains. While selected mindfulness-based interventions are effective in addressing symptoms of BPD, less is known regarding the effects of engaging in brief mindfulness practices on affective correlates of BPD. The present study investigated the effects of engaging in brief, daily mindfulness practice in a sample of young adults with elevated BPD symptoms. Ninety-two participants were recruited and randomly assigned to 2 weeks of daily mindfulness meditation or relaxation practice (active control), or to a no-practice control condition. Participants completed measures assessing depression, anxiety, stress, shame, difficulties with emotion regulation, trait mindfulness, and self-compassion before and after the practice period. Compared to the no-practice control condition, mindfulness practice resulted in significant improvements in trait mindfulness and self-compassion, whereas relaxation practice led to reductions in emotion regulation difficulties. No significant differences were found on any of the other outcomes between the mindfulness and relaxation conditions. The findings suggest that while both mindfulness and relaxation-based practices are effective in targeting selected transdiagnostic processes associated with BPD, more intensive interventions may be required for the practices to induce changes at the level of psychological symptoms.
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Lamers A, Toepper M, Fernando SC, Schlosser N, Bauer E, Woermann F, Driessen M, Beblo T. Nonacceptance of negative emotions in women with borderline personality disorder: association with neuroactivity of the dorsal striatum. J Psychiatry Neurosci 2019; 44:303-312. [PMID: 30964611 PMCID: PMC6710090 DOI: 10.1503/jpn.180077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Emotion dysfunction is a key symptom in patients with borderline personality disorder (BPD) and is considered a consequence of dysfunctional emotion regulation (e.g., reduced emotion acceptance). In the present functional MRI (fMRI) study, we investigated the neural correlates of habitual emotion acceptance in individuals with BPD. METHODS Female patients with BPD and female healthy controls passively viewed negative and neutral movie clips of faces during fMRI. We assessed emotion acceptance using the Emotion Acceptance Questionnaire (EAQ). To examine brain activation associated with habitual emotional acceptance of negative stimuli, the EAQ score was included as a regressor of interest in brain data analyses of activation intensity during negative compared with neutral movies. RESULTS We included 20 women with BPD and 20 heatlhy controls in our analysis. Compared with healthy controls, patients with BPD showed significantly more activation in frontostriatal brain regions (i.e., left superior frontal gyrus, right caudate) as well as in the left precuneus, left precentral gyrus, left posterior cingulate cortex and left hippocampus when confronted with negative (v. neutral) stimuli. Patients with BPD reported decreased emotion acceptance compared with healthy controls, and habitual emotion acceptance was inversely associated with activation of striatal areas (i.e., left putamen, left caudate) in patients with BPD. LIMITATIONS Causal conclusions are not possible. Comorbid diagnoses were not excluded, and only female participants were investigated. Stimuli were not rated immediately and may not be generalizable to all negative emotions. We cannot make any statements about other emotion-regulation strategies that may have been applied here. CONCLUSION Data indicate that striatal hyperactivation during the processing of negative stimuli in women with BPD is related to their decreased disposition to accept unpleasant emotional states. Thus, individuals with BPD may benefit from therapy approaches that focus on emotion acceptance in order to normalize emotional reactions.
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Affiliation(s)
- Agnes Lamers
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Max Toepper
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Silvia Carvalho Fernando
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Nicole Schlosser
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Eva Bauer
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Friedrich Woermann
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Martin Driessen
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
| | - Thomas Beblo
- From the Evangelisches Klinikum Bethel, Department of Psychiatry and Psychotherapy Bethel, Research Division, Germany (Lamers, Toepper, Fernando, Schlosser, Driessen, Beblo); the Bielefeld University, Department of Psychology, Beielefeld, Germany (Lamers, Driessen, Beblo); the University of Giessen, Cognitive Neuroscience at the Centre for Psychiatry, Germany (Bauer); and the Mara Hospital, Bethel Epilepsy Center, Bielefeld, Germany (Woermann)
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Carmona i Farrés C, Elices M, Soler J, Domínguez‐Clavé E, Martín‐Blanco A, Pomarol‐Clotet E, Salvador R, Martinez‐Horta S, Pascual JC. Effects of mindfulness training on the default mode network in borderline personality disorder. Clin Psychol Psychother 2019; 26:562-571. [DOI: 10.1002/cpp.2382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/13/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Cristina Carmona i Farrés
- Department of PsychiatryHospital de la Santa Creu I Sant Pau, IIB‐Sant Pau Barcelona Spain
- Department of Psychiatry and Legal MedicineAutonomous University of Barcelona, UAB Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
| | - Matilde Elices
- Department of PsychiatryHospital de la Santa Creu I Sant Pau, IIB‐Sant Pau Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
| | - Joaquim Soler
- Department of PsychiatryHospital de la Santa Creu I Sant Pau, IIB‐Sant Pau Barcelona Spain
- Department of Psychiatry and Legal MedicineAutonomous University of Barcelona, UAB Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
| | | | - Ana Martín‐Blanco
- Department of PsychiatryHospital de la Santa Creu I Sant Pau, IIB‐Sant Pau Barcelona Spain
- Department of Psychiatry and Legal MedicineAutonomous University of Barcelona, UAB Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
| | - Edith Pomarol‐Clotet
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
- FIDMAG Germanes Hospitalàries Research Foundation Barcelona Spain
| | - Raymond Salvador
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
- FIDMAG Germanes Hospitalàries Research Foundation Barcelona Spain
| | - Saül Martinez‐Horta
- Movement Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant Pau, IIB‐Sant Pau Barcelona Spain
| | - Juan C. Pascual
- Department of PsychiatryHospital de la Santa Creu I Sant Pau, IIB‐Sant Pau Barcelona Spain
- Department of Psychiatry and Legal MedicineAutonomous University of Barcelona, UAB Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Madrid Spain
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Didonna F, Rossi R, Ferrari C, Iani L, Pedrini L, Rossi N, Xodo E, Lanfredi M. Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive-compulsive disorder, major depressive disorder, or borderline personality disorder. Psychol Psychother 2019; 92:112-130. [PMID: 29575447 DOI: 10.1111/papt.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore differences in mindfulness facets among patients with a diagnosis of either obsessive-compulsive disorder (OCD), major depressive disorder (MDD), or borderline personality disorder (BPD), and healthy controls (HC), and their associations with clinical features. DESIGN AND METHOD One hundred and fifty-three patients and 50 HC underwent a clinical assessment including measures of mindfulness (Five Facets Mindfulness Questionnaire - FFMQ), psychopathological symptoms (Symptom Check List-90-R), dissociation (Dissociative Experience Scale), alexithymia (Alexithymia Scale 20), and depression (Beck Depression Inventory-II). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were performed to assess differences in mindfulness scores and their associations with clinical features. RESULTS The three diagnostic groups scored lower on all mindfulness facets (apart from FFMQobserving) compared to the HC group. OCD group had a significant higher FFMQ total score (FFMQ-TS) and FFMQacting with awareness compared to the BPD group, and scored higher on FFMQdescribing compared to BPD and MDD groups. The scores in non-judging facet were significantly lower in all the three diagnostic groups compared to the HC group. Interestingly, higher FFMQ-TS was inversely related to all psychological measures, regardless of diagnostic group. CONCLUSIONS Deficits in mindfulness skills were present in all diagnostic groups. Furthermore, we found disease-specific relationships between some mindfulness facets and specific psychological variables. Clinical implications are discussed. PRACTITIONER POINTS The study showed deficits in mindfulness scores in all diagnostic groups compared to a healthy control group. Overall, mindfulness construct has a significantly negative association with indexes of global distress, dissociative symptoms, alexithymia, and depression. Mindfulness-based interventions in clinical settings should take into account different patterns of mindfulness skills and their impact on disease-specific maladaptive cognitive strategies or symptomatology.
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Affiliation(s)
- Fabrizio Didonna
- Unit for OCD, Department of Psychiatry, Villa Margherita Private Hospital, Vicenza, Italy.,Italian Institute for Mindfulness, Vicenza, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luca Iani
- Department of Human Sciences, European University of Rome, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nicoletta Rossi
- Unit for OCD, Department of Psychiatry, Villa Margherita Private Hospital, Vicenza, Italy
| | - Erica Xodo
- Italian Institute for Mindfulness, Vicenza, Italy
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Cole WR, Brockway JA, Fann JR, Ahrens AP, Hurst S, Hart T, Vuletic S, Bush N, Bell KR. Expressions of emotional distress in active duty military personnel with mild traumatic brain injury: A qualitative content analysis. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2018.1503022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Wesley R. Cole
- Defense and Veterans Brain Injury Center, GDHS, Intrepid Spirit, Fort Bragg, North Carolina
| | - Jo Ann Brockway
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Angelica P. Ahrens
- Defense and Veterans Brain Injury Center, GDHS, Intrepid Spirit, Fort Bragg, North Carolina
| | - Samantha Hurst
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - Simona Vuletic
- National Center for Telehealth and Technology (T2), Joint Base Lewis-McChord, Washington
| | - Nigel Bush
- National Center for Telehealth and Technology (T2), Joint Base Lewis-McChord, Washington
- Psychological Health Center of Excellence, Defense Health Agency, Joint Base Lewis-McChord, Washington
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas
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40
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Brett EI, Espeleta HC, Lopez SV, Leavens ELS, Leffingwell TR. Mindfulness as a mediator of the association between adverse childhood experiences and alcohol use and consequences. Addict Behav 2018; 84:92-98. [PMID: 29653433 DOI: 10.1016/j.addbeh.2018.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Abstract
One-third of college students report past-year heavy episodic drinking, making college student alcohol use an important area for continued research. Research has consistently linked early experiences of adversity to problematic substance use in adolescence and adulthood. Given the negative health consequences associated with heavy episodic drinking, it is imperative to identify mechanisms that contribute to this relation. Low levels of mindfulness have been linked to early adversity as well as impulsivity and alcohol use, therefore, the current study aims to examine the mediating role of mindfulness in the relation between early adversity and current alcohol use and consequences. Undergraduate students (N = 385) at a Midwestern university completed an online questionnaire assessing experiences of childhood adversity, trait mindfulness, and current alcohol use and related consequences. Results indicated that increased adverse experiences and lower levels of mindfulness predicted both increased alcohol consumption and consequences (ps < 0.025), with mindfulness mediating the relationships. Mindfulness is a predictor of alcohol outcomes and appears to mediate the relation between early adversity and alcohol use and consequences. Findings suggest that students with a history of adversity are more likely to exhibit lower levels of mindfulness, which may lead to an increase in alcohol consumption and consequences in early adulthood. Targeted alcohol intervention efforts that incorporate mindfulness skills may be particularly beneficial for those who have experienced early adversity.
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Affiliation(s)
- Emma I Brett
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
| | - Hannah C Espeleta
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Susanna V Lopez
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | - Thad R Leffingwell
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
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Tortella-Feliu M, Soler J, Burns L, Cebolla A, Elices M, Pascual JC, López Del Hoyo Y, Baños R, García-Campayo J. Relationship between effortful control and facets of mindfulness in meditators, non-meditators and individuals with borderline personality disorder. Personal Ment Health 2018; 12:265-278. [PMID: 29781245 DOI: 10.1002/pmh.1420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/07/2018] [Indexed: 12/16/2022]
Abstract
As dimensions of effortful control (EC), activation control, attentional control, and inhibitory control could mediate the relationship between mindfulness meditation practice and the facets of mindfulness (i.e., observing, describing, acting with awareness, non-judging and non-reacting to inner experience). In this study, we tested whether participant status: meditators (n = 330), healthy non-meditators (n = 254) and individuals with borderline personality disorder (BPD) diagnosis (n = 46) predicted the facets of mindfulness and if these potential effects were mediated through the three effortful control (EC) dimensions (activation, attentional and inhibitory control). Meditators scored higher than non-meditators on attentional and inhibitory control and on the facets of mindfulness with attentional and inhibitory control partially mediating this relationship between meditation status and mindfulness facets. Participants with BPD showed lower scores on EC along with lower scores on the facets of mindfulness compared with healthy non-meditators. All three aspects of EC partially mediated the relationship between BPD and mindfulness facets. Copyright © 2018 John Wiley & Sons, Ltd.
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Affiliation(s)
- Miquel Tortella-Feliu
- University Research Institute on Health Sciences IUNICS - IdiSPA, University of the Balearic Islands, Palma (Mallorca), Spain
| | - Joaquim Soler
- Department of Psychiatry, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Leonard Burns
- Department of Psychology, Washington State University, Pullman, United States of America
| | - Ausiàs Cebolla
- Department of Personality, Assessment, and Psychological Treatments, University of Valencia, València, Spain.,CIBERObn Ciber physiopathology of obesity and nutrition, Madrid, Spain
| | - Matilde Elices
- Department of Psychiatry, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Juan C Pascual
- Department of Psychiatry, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Yolanda López Del Hoyo
- Aragon Institution of Health Science (I+CS), Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network ( RedIAPP), Madrid, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Rosa Baños
- Department of Personality, Assessment, and Psychological Treatments, University of Valencia, València, Spain.,CIBERObn Ciber physiopathology of obesity and nutrition, Madrid, Spain
| | - Javier García-Campayo
- Aragon Institution of Health Science (I+CS), Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network ( RedIAPP), Madrid, Spain.,Department of Psychiatry, Miguel Servet Hospital, University of Zaragoza, Zaragoza, Spain
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McHugh C, Balaratnasingam S. Impulsivity in personality disorders: current views and future directions. Curr Opin Psychiatry 2018; 31:63-68. [PMID: 29120916 DOI: 10.1097/yco.0000000000000383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Impulsivity is considered a trans-diagnostic feature of many mental disorders, yet our understanding of the concept and approaches to measurement have evolved significantly with advances in neuroimaging. This review will provide an overview of impulsivity as it is currently understood, its association with personality disorder and implications for treatment. RECENT FINDINGS Impulsivity is now considered to involve failure of inhibitory control, either motor or cognitive, and deficits of the reward valuation system. Inhibitory control, and discounting of rewards are both independently associated with personality disorder. The tendency to choose immediate rewards over those with an associated delay is a feature of borderline personality disorder (BPD) regardless of conditions of stress. Deficits in response inhibition were also associated with BPD and were worsened under conditions of stress. These findings indicate that state impulsivity has an important role in the expression of impulsive behaviour. Exploratory studies measuring changes in these networks following psychotherapy have confirmed such methods could be used to measuring treatment response. SUMMARY Understanding the discrete mechanisms of impulsive decision-making and behavior, and their implications in personality disorder, offers new targets for diagnosis and intervention. Future research should aim to understand changes of impulsivity with development. Identifying the role of psychological and pharmacological intervention in modulating the development of impulsivity may prevent progression to personality disorder, and associated adverse outcomes.
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Affiliation(s)
| | - Sivasankaran Balaratnasingam
- Faculty of Health and Medical Sciences, University of Western Australia, Western Australia.,The Cairns Clinic, Queensland, Australia
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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: 60] [Impact Index Per Article: 8.6] [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.
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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
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Prada P, Zamberg I, Bouillault G, Jimenez N, Zimmermann J, Hasler R, Aubry JM, Nicastro R, Perroud N. EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study. Perspect Psychiatr Care 2017; 53:289-298. [PMID: 27439663 DOI: 10.1111/ppc.12178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We developed a smartphone application (App; EMOTEO: emotion-meteo [weather forecast]) to help borderline personality disorder (BPD) patients to monitor and regulate their inner tension. The App proposes targeted mindfulness-based exercises. DESIGN AND METHODS We assessed the usability and efficiency of this App for monitoring and reduction of aversive tension in 16 BPD participants over a 6-month period. FINDINGS We recorded a mean of 318.1 sessions (SD = 166.7) per participants, with a high level of satisfaction. There was a significant decrease in aversive tension (p < .05) and the App was mainly used around 10 a.m. and 9 p.m. PRACTICE IMPLICATIONS EMOTEO was user-friendly and efficient in reducing aversive tension in BPD patients.
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Affiliation(s)
- Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Ido Zamberg
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Gérald Bouillault
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Naya Jimenez
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Zimmermann
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW Impulsivity is a multifaceted construct and an important personality trait in various mental health conditions. Among personality disorders (PDs), especially cluster B PDs are affected. The aims of this review are to summarize the relevant findings of the past 3 years concerning impulsivity in cluster B PDs and to identify those subcomponents of self-reported impulsivity and experimentally measured impulse control that are most affected in these disorders. RECENT FINDINGS All studies referred to antisocial (ASPD) or borderline PD (BPD), and none were found for narcissistic or histrionic PD. In ASPD as well as BPD, self-report scales primarily revealed heightened impulsivity compared to healthy controls. In experimental tasks, ASPD patients showed impairments in response inhibition, while fewer deficits were found in delay discounting. BPD patients showed specific impairments in delay discounting and proactive interference, while response inhibition was less affected. However, after inducing high levels of stress, deficits in response inhibition could also be observed in BPD patients. Furthermore, negative affect led to altered brain activation patterns in BPD patients during impulse control tasks, but no behavioral impairments were found. As proposed by the DSM-5 alternative model for personality disorders, heightened impulsivity is a core personality trait in BPD and ASPD, which is in line with current research findings. However, different components of experimentally measured impulse control are affected in BPD and ASPD, and impulsivity occurring in negative emotional states or increased distress seems to be specific for BPD. Future research could be focused on measures that assess impulsive behaviors on a momentary basis as this is a promising approach especially for further ecological validation and transfer into clinical practice.
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Elices M, Soler J, Feliu-Soler A, Carmona C, Tiana T, Pascual JC, García-Palacios A, Álvarez E. Combining emotion regulation and mindfulness skills for preventing depression relapse: a randomized-controlled study. Borderline Personal Disord Emot Dysregul 2017; 4:13. [PMID: 28690851 PMCID: PMC5497384 DOI: 10.1186/s40479-017-0064-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behavioral therapy (DBT) skills have become increasingly used to treat several psychiatric conditions, including major depressive disorder (MDD). The aim of the study was to investigate the efficacy of an intervention that combines emotion regulation and mindfulness skills of DBT to prevent depression relapse/recurrence. METHODS A total of 75 individuals (79% females; mean age, 52 years) with a diagnosis of MDD in complete or partial remission were recruited. Participants were randomly allocated either to an intervention combining emotion regulation and mindfulness skills (ER + M group, n = 37) or to a psychoeducative program (n = 38). After the 10-week treatment period, participants were followed for 1 year. Analyses were run in per-protocol (PP) and intention-to-treat (ITT) samples. The primary outcome measure was time to depression relapse/recurrence. RESULTS ER + M training was not more effective than the control intervention in preventing depression relapse. However, PP and ITT analyses showed that participants trained in ER + M presented a significant reduction in depressive symptoms and overall psychopathology. Based on the PP and ITT analyses, neither of the interventions were related with an increase in dispositional mindfulness. CONCLUSIONS More studies are needed to confirm the efficacy of ER + M to decrease depressive symptoms and overall psychopathology. TRIAL REGISTRATION NCT02747134. Registered on 20 April 2016.
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Affiliation(s)
- Matilde Elices
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Programa de Cognición, Instituto de Fundamentos y Métodos en Psicología, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Joaquim Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Feliu-Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain. Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
| | - Cristina Carmona
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thais Tiana
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Juan C Pascual
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Enric Álvarez
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
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Montero-Marin J, Puebla-Guedea M, Herrera-Mercadal P, Cebolla A, Soler J, Demarzo M, Vazquez C, Rodríguez-Bornaetxea F, García-Campayo J. Psychological Effects of a 1-Month Meditation Retreat on Experienced Meditators: The Role of Non-attachment. Front Psychol 2016; 7:1935. [PMID: 28018270 PMCID: PMC5149565 DOI: 10.3389/fpsyg.2016.01935] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/25/2016] [Indexed: 11/16/2022] Open
Abstract
Background: There are few studies devoted to assessing the impact of meditation-intensive retreats on the well-being, positive psychology, and personality of experienced meditators. We aimed to assess whether a 1-month Vipassana retreat: (a) would increase mindfulness and well-being; (b) would increase prosocial personality traits; and (c) whether psychological changes would be mediated and/or moderated by non-attachment. Method: A controlled, non-randomized, pre-post-intervention trial was used. The intervention group was a convenience sample (n = 19) of experienced meditators who participated in a 1-month Vipassana meditation retreat. The control group (n = 19) comprised matched experienced meditators who did not take part in the retreat. During the retreat, the mean duration of daily practice was 8–9 h, the diet was vegetarian and silence was compulsory. The Experiences Questionnaire (EQ), Non-attachment Scale (NAS), Positive and Negative Affect Schedule (PANAS), Satisfaction With Life Scale (SWLS), Temperament Character Inventory Revised (TCI-R-67), Five Facets Mindfulness Questionnaire (FFMQ), Self-Other Four Immeasurables (SOFI) and the MINDSENS Composite Index were administered. ANCOVAs and linear regression models were used to assess pre-post changes and mediation/moderation effects. Results: Compared to controls, retreatants showed increases in non-attachment, observing, MINDSENS, positive-affect, balance-affect, and cooperativeness; and decreases in describing, negative-others, reward-dependence and self-directedness. Non-attachment had a mediating role in decentring, acting aware, non-reactivity, negative-affect, balance-affect and self-directedness; and a moderating role in describing and positive others, with both mediating and moderating effects on satisfaction with life. Conclusions: A 1-month Vipassana meditation retreat seems to yield improvements in mindfulness, well-being, and personality, even in experienced meditators. Non-attachment might facilitate psychological improvements of meditation, making it possible to overcome possible ceiling effects ascribed to non-intensive practices.
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Affiliation(s)
- Jesus Montero-Marin
- Faculty of Health and Sport Sciences, Primary Care Prevention and Health Promotion Research Network, Zaragoza, Centro de Investigación Biomédica en Red de Salud Mental, Zaragoza, Spain
| | - Marta Puebla-Guedea
- Centro de Investigación Biomédica en Red de Salud Mental, Primary Care Prevention and Health Promotion Research Network, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Paola Herrera-Mercadal
- Centro de Investigación Biomédica en Red de Salud Mental, Primary Care Prevention and Health Promotion Research Network, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Ausias Cebolla
- Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain.,CIBERObn Ciber Physiopathology of Obesity and Nutrition, Santiago de Compostela, Spain
| | - Joaquim Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau (Barcelona), Departamento de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Marcelo Demarzo
- Mente Aberta – Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Carmelo Vazquez
- Professor of Psychopathology, Universidad Complutense de Madrid, Red PROMOSAM, Valencia, Spain
| | | | - Javier García-Campayo
- Miguel Servet Hospital and University of Zaragoza, Primary Care Prevention and Health Promotion Research Network, Instituto de Investigación Sanitaria Aragón (IIS Aragon), Centro de Investigación Biomédica en Red de Salud Mental, Zaragoza, Spain
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