1
|
Lucre K, Ashworth F, Copello A, Jones C, Gilbert P. Compassion Focused Group Psychotherapy for attachment and relational trauma: Engaging people with a diagnosis of personality disorder. Psychol Psychother 2024. [PMID: 38305507 DOI: 10.1111/papt.12518] [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: 06/20/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The research aimed to evaluate an exploratory Compassion Focused Group Psychotherapy Programme and the impact on participants' experiences of self-criticism, usage of services and general wellbeing. Participants included patients with a history of complex attachment and relational trauma (A&RT), who might attract a diagnosis of personality disorder. DESIGN This study utilised a quasi-experimental non-randomised within subject controlled design for the evaluation of the efficacy of the programme. METHODS Participants were recruited from tertiary care services. The programme consisted of a 12-week Preparation and Engagement intervention (PEG) which was Compassionate Mind Training and Psychoeducation, followed by a 40-week Compassion Focused Trauma Group intervention. The cohort was then followed up after 12 months during which period they received treatment as usual. A comprehensive selection of self-report measures was administered at various points during the therapeutic process and following completion of the group interventions. RESULTS The results of the research showed that the provision of a long-term, slow-paced, Compassion Focused Group Psychotherapy intervention, resulted in significant changes across all measures which were maintained at 12-month follow-up. These significant results were maintained following intention to treat and reliable change analyses. These data were supported by a significant reduction in service usage and a significant increase in engagement in employment and education. CONCLUSIONS This study has identified that within Compassion Focused Group Psychotherapy, there is a therapeutic process of establishing group-based safeness as a necessary precursor to cultivating compassion and reworking early shame-based trauma memories.
Collapse
Affiliation(s)
- Kate Lucre
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | - Alex Copello
- School of Psychology University of Birmingham & Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Chris Jones
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Paul Gilbert
- Centre for Compassion Research and Training, College of Health, Psychology and Social Care, University of Derby, Derby, UK
| |
Collapse
|
2
|
Pedersen G, Wilberg T, Hummelen B, Hartveit Kvarstein E. The Norwegian network for personality disorders - development, contributions and challenges through 30 years. Nord J Psychiatry 2022:1-9. [PMID: 36409693 DOI: 10.1080/08039488.2022.2147995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Established in 1992, the Norwegian Network for Personality Disorders (The Network) is a clinical research collaboration of specialist mental health and addiction services in Norway. Its primary focus is to facilitate systematic and relevant clinical assessment for patients with personality disorder and evaluate progress in psychotherapeutic treatment. However, large-scale data registers for personality disorder are still unique. This article presents the circumstances that led to the establishment of the Network, and its development and challenges in many areas, and through various phases. METHODS In the following, we will outline how this close interaction between researchers, clinicians, and well-adapted systems has facilitated cooperation and clinical research. We will highlight some key factors that have been decisive during the network's development, and not least for further adaptation and existence. RESULTS Through 30 years, the Network has succeeded in establishing a large and sustainable clinical research collaboration with a persistent focus on personality disorder and psychotherapeutic treatment. The collaboration has resulted in a broad range of scientific contributions to the understanding of personality disorder, assessment and measurement methods, treatment alliance, clinical outcomes, service utilization, and costs. In addition, The Network has also resulted in a number of synergy effects that have benefited clinicians, patients, and researchers. CONCLUSIONS The Norwegian Network for Personality Disorders has become an acknowledged institution in the field. Many aspects of its development, organization, maintenance, and solutions to challenges may be relevant to others who plan to establish, maintain, or further develop similar collaborations.
Collapse
Affiliation(s)
- Geir Pedersen
- Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,The Norwegian Centre of Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theresa Wilberg
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Enhancing member engagement in a Tier 3 personality disorder service during COVID-19: evaluation of a virtual group programme. Behav Cogn Psychother 2022; 50:629-643. [PMID: 36082688 DOI: 10.1017/s1352465822000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drop-out rates from evidence-based interventions for people with a diagnosis of personality disorder (PD) are high. The COVID-19 pandemic has likely exacerbated barriers to engagement with the introduction of virtual working. Virtual therapy has a good evidence-base for Axis I disorders, but limited research for Axis II disorders. AIMS To investigate facilitators and barriers to engagement in a Tier 3 PD service virtual group programme. METHOD A virtual group programme was developed in collaboration with service members, and analysed members' attendance rates over a 5-month period pre- and post-COVID-19. Thematic analysis of semi-structured telephone interviews with 38 members is reported, describing their experience of the virtual group programme. RESULTS Attendance rates were significantly higher pre-COVID (72%) than post-COVID (50%). Thematic analysis highlighted key barriers to attendance were: practical issues, low motivation, challenges of working in a group online and feeling triggered at home. Main promoters of engagement were: feeling valued, continued sense of connection and maintaining focus on recovery. DISCUSSION The results suggest that the pandemic has exacerbated relational and practical barriers to engagement in a Tier 3 PD service. Ways of enhancing engagement are discussed, as well as preliminary recommendation for services offering virtual therapy to people with a diagnosis of PD.
Collapse
|
4
|
Schwierige Gruppensituationen als Herausforderung und Sollbruchstelle in der Gruppenarbeit. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2022. [DOI: 10.13109/grup.2022.58.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
5
|
Kvarstein EH, Zahl KE, Stänicke LI, Pettersen MS, Baltzersen ÅL, Johansen MS, Eikenaes IUM, Arnevik EA, Hummelen B, Wilberg T, Pedersen G. Vulnerability of personality disorder during the Covid-19 crises - a multicenter survey of treatment experiences among patients referred to treatment. Nord J Psychiatry 2022; 76:52-63. [PMID: 34126854 DOI: 10.1080/08039488.2021.1934110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementation of treatment modifications was required for patients typically characterized by insecure attachment and vulnerability to separation. AIM To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD. DESIGN A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs. RESULTS The response-rate was 12% (N = 133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly telephone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations. CONCLUSION The survey confirms a radical modification from comprehensive group-based PD programs to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable concern about treatment progress.
Collapse
Affiliation(s)
- Elfrida Hartveit Kvarstein
- Department for National and Regional Functions, Division of Mental Health and Addiction, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell-Einar Zahl
- Group Therapy Section, Follo District Psychiatric Centre, Akershus University Hospital, Nordbyhagen, Norway
| | - Line Indrevoll Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway.,Nic Waals Institute, Lovisenberg Deacon Hospital, Oslo, Norway
| | - Mona Skjeklesaether Pettersen
- Department of Substance Abuse, Clinic for Mental Health and Addiction Treatment, University Hospital of North Norway, Tromsø, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Åse-Line Baltzersen
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Merete Selsbakk Johansen
- Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Ingeborg Ulltveit-Moe Eikenaes
- Department for National and Regional Functions, Division of Mental Health and Addiction, National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| | - Espen Ajo Arnevik
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department for Research and Innovation, Division of Mental Health and Addiction, Section for Treatment Research, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for Research and Innovation, Division of Mental Health and Addiction, Section for Clinical Addiction Research, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department for National and Regional Functions, Division of Mental Health and Addiction, Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
6
|
Sheridan Rains L, Echave A, Rees J, Scott HR, Lever Taylor B, Broeckelmann E, Steare T, Barnett P, Cooper C, Jeynes T, Russell J, Oram S, Rowe S, Johnson S. Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis. PLoS One 2021; 16:e0248316. [PMID: 33914750 PMCID: PMC8084224 DOI: 10.1371/journal.pone.0248316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a "personality disorder" diagnosis. Services should be informed by the views of people with these experiences. AIMS To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. METHODS We searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist "personality disorder" services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes. RESULTS Forty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of 'personality disorder' diagnosis. Themes tended to recur across studies from different countries and years. DISCUSSION Recurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist "personality disorder" services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with "personality disorders" throughout the mental health care system.
Collapse
Affiliation(s)
- Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Athena Echave
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jessica Rees
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Billie Lever Taylor
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Eva Broeckelmann
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Thomas Steare
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Phoebe Barnett
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Chris Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tamar Jeynes
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jessica Russell
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sian Oram
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
7
|
Paquin JD, Abegunde C, Hahn A, Fassinger RE. A Brief History of Group Therapy as a Field and the Representation of Women in Its Development. Int J Group Psychother 2021; 71:13-80. [PMID: 38449141 DOI: 10.1080/00207284.2020.1798176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article explores the place of women in the specialization of group psychotherapy, particularly their representation in journal publications, both in topical coverage related to women as well as in editorial participation and leadership. We first present a brief history of group psychotherapy to provide overall context. Next, we present major cross-cutting themes related to women and group work that emerged from our review of nine peer-reviewed journals deemed most relevant to our investigation. We end with observations and a call for greater inclusion of women in the group psychotherapy literature.
Collapse
|
8
|
Andersen CF, Poulsen S, Fog-Petersen C, Jørgensen MS, Simonsen E. Dropout from mentalization-based group treatment for adolescents with borderline personality features: A qualitative study. Psychother Res 2020; 31:619-631. [PMID: 32878583 DOI: 10.1080/10503307.2020.1813914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: Premature termination, or dropout, is a major concern in psychotherapy in general and an issue of particular importance in treatments for borderline personality disorder (BPD). Yet few studies investigating dropout from therapy in adolescent BPD populations exist. This study investigates reasons for dropping out from group-based mentalization-based treatment (MBT-G) for BPD or borderline features in an adolescent population.Method: Ten semi-structured interviews were performed with female adolescents who had dropped out from group-based MBT for BPD. The data were analyzed qualitatively using Systematic Text Condensation.Results: The results point to the existence of a subgroup of adolescent BPD patients who do not perceive the treatment sufficiently helpful or worthwhile, who experienced treatment as emotionally demanding, time-consuming and connected with unpleasant experiences. Positive reasons for early termination were reported in the form of experienced improvement in condition. Dropping out became understood as a process of weighing perceived benefits against perceived costs of staying in treatment. This understanding of dropout as a process implies the existence of a window of time where intervention to prevent dropout is possible, presupposing the detection of at-risk patients.
Collapse
Affiliation(s)
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Fog-Petersen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatry West, Region Zealand, Slagelse, Denmark
| | | | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Desrosiers L, Saint-Jean M, Laporte L, Lord MM. Engagement complications of adolescents with borderline personality disorder: navigating through a zone of turbulence. Borderline Personal Disord Emot Dysregul 2020; 7:18. [PMID: 32884818 PMCID: PMC7460802 DOI: 10.1186/s40479-020-00134-6] [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: 02/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. METHOD A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). RESULTS Well before dropout occurs, different phenomena identified as "engagement complications" characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a "zone of turbulence" which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. CONCLUSION Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.
Collapse
Affiliation(s)
- Lyne Desrosiers
- Université du Québec à Trois-Rivières, C.P. 500, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5H7 Canada
- Centre de Recherche et d’Expertise-Jeunes en Difficulté, CIUSS Centre-sud-de-l’île-de-Montréal, Montréal, Québec Canada
| | | | - Lise Laporte
- Centre de Recherche et d’Expertise-Jeunes en Difficulté, CIUSS Centre-sud-de-l’île-de-Montréal, Montréal, Québec Canada
- McGill University Health Centre, Montréal, Québec Canada
| | - Marie-Michèle Lord
- Université du Québec à Trois-Rivières, C.P. 500, 3351 Boul. des Forges, Trois-Rivières, Québec G9A 5H7 Canada
| |
Collapse
|
10
|
Psychotherapy for personality disorders: Short-term day hospital psychotherapy versus outpatient individual therapy – a randomized controlled study. Eur Psychiatry 2020; 24:71-8. [DOI: 10.1016/j.eurpsy.2008.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 09/10/2008] [Accepted: 09/19/2008] [Indexed: 11/17/2022] Open
Abstract
AbstractThis article describes the results of an eight-month follow-up investigation from a randomized controlled trial of day hospital psychotherapy (DHP) compared with outpatient individual psychotherapy (OIP) for patients with personality disorders (N = 114). The patients were randomly assigned to either 18 weeks of day hospital treatment followed by long-term conjoint group and individual therapy (DHP), or outpatient individual psychotherapy (OIP). The main outcome measures were attrition rate, suicide attempts, suicidal thoughts, self-injury, psychosocial functioning, symptom distress, and interpersonal and personality problems. The study showed a low dropout rate and a moderate improvement on a broad range of clinical measures for both treatments. However, there was no indication of the superiority of one treatment over the other. Neither was there any indication that day hospital treatment was better for the most poorly functioning patients. Further studies will follow this group of patients for the next few years, the results of which may have implications for resource allocation and the organization of mental health services for patients with personality disorders.
Collapse
|
11
|
Bakland M, Rosenvinge JH, Wynn R, Sørlie V, Sundgot-Borgen J, Fostervold Mathisen T, Hanssen TA, Jensen F, Innjord K, Pettersen G. A new treatment for eating disorders combining physical exercise and dietary therapy (the PED-t): experiences from patients who dropped out. Int J Qual Stud Health Well-being 2020; 15:1731994. [PMID: 32081086 PMCID: PMC7048200 DOI: 10.1080/17482631.2020.1731994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Purpose: Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining physical exercise and dietary therapy (PED-t).Methods: We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach.Results: Three themes emerged: "standing on the outside", "unmet expectations" and "participation not a waste of time". Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced.Conclusion: A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.
Collapse
Affiliation(s)
- Maria Bakland
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Department of Psychology, UiT - The Artic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, UiT - The Artic University of Norway, Tromsø, Norway.,Division of Addictions and Mental Health, University Hospital of North Norway, Tromsø, Norway
| | - Venke Sørlie
- Center for clinical nursing research, Lovisenberg Deaconal University College, Oslo, Norway
| | | | | | - Tove Aminda Hanssen
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Heart Disease, University Hospital of North Norway, Tromsø, Norway
| | - Franziska Jensen
- Department of Language and Culture, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Education, UiT - The Artic University of Norway, Tromsø, Norway.,The Eating Disorder Association "Spisfo", Tromsø, Norway
| | | | - Gunn Pettersen
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway
| |
Collapse
|
12
|
Mentalisierungsbasierte Gruppentherapie (MBT-G) – eine Pilotstudie über Patientinnen mit Persönlichkeitsstörungen und Substanzmissbrauch. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2019. [DOI: 10.13109/grup.2019.55.3.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Morken KTE, Binder PE, Arefjord NM, Karterud SW. Mentalization-Based Treatment From the Patients' Perspective - What Ingredients Do They Emphasize? Front Psychol 2019; 10:1327. [PMID: 31244726 PMCID: PMC6582192 DOI: 10.3389/fpsyg.2019.01327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim of this study was to explore how patients with personality disorder (PD) and substance use disorder (SUD) experience mentalization-based treatment (MBT), in particular what they consider useful and less useful elements of the therapy. Method: Semi-structured qualitative interviews with 13 participants were conducted. Participants were interviewed on their experience of the different elements of MBT, their experience of working in the transference, and their view on MBT as a whole. Thematic analyses were performed within a hermeneutical-phenomenological epistemology, with an emphasis on researcher reflexivity. Results: The following themes were found in the material: “I am not alone,” “Taking blinders off,” “Just say it,” “The paradox of trust,” and “Follow me closely.” Three of these themes concerned therapist interventions; these involved addressing the relationship with the patients, addressing negative or unspoken feelings in the sessions, and validating and tolerating patients’ affect. Two themes concerned group therapy experiences; these were the experience of sameness with co-patients in group and the experience of discovering different perspectives in group. Conclusions: Patients’ experiences of useful elements in MBT resonate with theoretical tenets of (borderline) personality pathology, in particular attachment disturbances and emotional dysregulation. Patients highlight what we would label working in the therapeutic relationship, addressing transferential and counter-transferential processes explicitly, emotional validation, and enhancing mentalizing in its own right.
Collapse
Affiliation(s)
- Katharina Teresa Enehaug Morken
- Bergen Clinics Foundation, Bergen, Norway.,Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Per-Einar Binder
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | | |
Collapse
|
14
|
Vázquez-Bourgon J, Gómez Ruiz E, Hoyuela Zatón F, Salvador Carulla L, Ayesa Arriola R, Tordesillas Gutiérrez D, Crespo Facorro B. Differences between psychiatric disorders in the clinical and functional effectiveness of an acute psychiatric day hospital, for acutely ill psychiatric patients. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 14:40-49. [PMID: 31160228 DOI: 10.1016/j.rpsm.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intensive treatment in acute day-care psychiatric units may represent an efficient alternative to inpatient care. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder. The primary aim of this study was to explore differences between main psychiatric diagnostic groups, in the effectiveness of an acute partial hospitalization program. And, to identify predictors of treatment response. MATERIAL AND METHODS The study was conducted at an acute psychiatric day hospital. Clinical severity was assessed using BPRS, CGI, and the HoNOS scales. Main socio-demographic variables were also recorded. Patients were clustered into 4wide diagnostic groups (i.e.: non-affective psychosis; bipolar; depressive; and personality disorders) to facilitate statistical analyses. RESULTS A total of 331 participants were recruited, 115 of whom (34.7%) were diagnosed with non-affective psychosis, 97 (28.3%) with bipolar disorder, 92 (27.8%) with affective disorder, and 27 (8.2%) with personality disorder. Patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F=5.30; P=0.001) and CGI (F=8.78; P<0.001) than those suffering from psychosis or depressive disorder. Longer length of stay in the day-hospital, and greater baseline BPRS severity, were identified as predictors of good clinical response. Thirty-day readmission rate was 3%; at long-term (6 months after discharge) only 11.8% (N=39) of patients were re-admitted to a psychiatric hospitalization unit, and no differences were observed between diagnostic groups. CONCLUSIONS Intensive care in an acute psychiatric day hospital is feasible and effective for patients suffering from an acute mental disorder. However, this effectiveness differs between diagnostic groups.
Collapse
Affiliation(s)
- Javier Vázquez-Bourgon
- Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Santander, España.
| | - Elsa Gómez Ruiz
- Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - Fernando Hoyuela Zatón
- Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - Luis Salvador Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Rosa Ayesa Arriola
- Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Santander, España
| | - Diana Tordesillas Gutiérrez
- Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Santander, España; Unidad de Neuroimagen y Servicios Tecnológicos, IDIVAL, Santander, España
| | - Benedicto Crespo Facorro
- Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Santander, España
| |
Collapse
|
15
|
Lamont E, Dickens GL. Mental health services, care provision, and professional support for people diagnosed with borderline personality disorder: systematic review of service-user, family, and carer perspectives. J Ment Health 2019; 30:619-633. [DOI: 10.1080/09638237.2019.1608923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Emma Lamont
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Geoffrey L. Dickens
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
| |
Collapse
|
16
|
Kvarstein EH, Pedersen G, Folmo E, Urnes Ø, Johansen MS, Hummelen B, Wilberg T, Karterud S. Mentalization-based treatment or psychodynamic treatment programmes for patients with borderline personality disorder - the impact of clinical severity. Psychol Psychother 2019; 92:91-111. [PMID: 29582581 PMCID: PMC6585931 DOI: 10.1111/papt.12179] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/23/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Mentalization-based treatment (MBT), originally designed for patients with borderline personality disorder (BPD), may be particularly indicated for severe conditions. However, there is limited documentation of how increasing severity of personality disorder (PD) effect outcomes of highly specialized treatments. This study aimed to investigate associations between clinical severity and outcomes for patients in MBT as compared to a psychodynamic group-based treatment programme (PDT). DESIGN A naturalistic, longitudinal, comparison study. METHODS The sample included 345 patients with BPD (PDTn = 281, MBTn = 64). The number of diagnosed PDs, PD criteria, and symptom disorders were chosen as baseline indicators of clinical severity. Clinical outcomes (global functioning, symptom distress, interpersonal problems) were repeatedly assessed over three years. Therapists' fidelity to MBT was satisfactory. Linear mixed models were the applied statistics. RESULTS In PDT, greater clinical severity was associated with poorer improvement rates. Clinical severity was not associated with significant differences in outcomes for patients in MBT. Differences in outcomes for patients in MBT and PDT increased significantly with higher severity of disorder. CONCLUSIONS Supporting previous research, this study indicates that clinical benefits associated with MBT also apply for BPD patients with severe conditions. The results also suggest that increasing severity was a challenge in PDT. PRACTITIONER POINTS MBT may be particularly beneficial for severely disordered BPD patients Differences between MBT and PDT were less pronounced in moderately disordered BPD patients.
Collapse
Affiliation(s)
| | - Geir Pedersen
- Section for Personality PsychiatryOslo University HospitalNorway,University of OsloNorway
| | - Espen Folmo
- Section for Personality PsychiatryOslo University HospitalNorway
| | - Øyvind Urnes
- Section for Personality PsychiatryOslo University HospitalNorway
| | | | - Benjamin Hummelen
- Department of Research and DevelopmentOslo University HospitalNorway
| | - Theresa Wilberg
- Section for Personality PsychiatryOslo University HospitalNorway,Department of Research and DevelopmentOslo University HospitalNorway
| | - Sigmund Karterud
- Section for Personality PsychiatryOslo University HospitalNorway
| |
Collapse
|
17
|
Morken KTE, Binder PE, Arefjord N, Karterud S. Juggling thoughts and feelings: How do female patients with borderline symptomology and substance use disorder experience change in mentalization-based treatment? Psychother Res 2017; 29:251-266. [DOI: 10.1080/10503307.2017.1325021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Katharina T. E. Morken
- MBT Team, The Bergen Clinic Foundation, Bergen, Norway
- Institute for Clinical Psychology, University of Bergen, Bergen, Norway
| | - Per Einar Binder
- Institute for Clinical Psychology, University of Bergen, Bergen, Norway
| | - Nina Arefjord
- Competence Centre on Drug and Alcohol, The Bergen Clinic Foundation, Bergen, Norway
| | | |
Collapse
|
18
|
Kvarstein EH, Nordviste O, Dragland L, Wilberg T. Outpatient psychodynamic group psychotherapy - outcomes related to personality disorder, severity, age and gender. Personal Ment Health 2017; 11:37-50. [PMID: 27766761 DOI: 10.1002/pmh.1352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/07/2016] [Accepted: 08/27/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Outpatient group psychotherapy is frequent within specialist services, recruits a mixed population, but effects are poorly documented. This study investigates long-term outcomes for patients with personality disorder (PD) treated in outpatient, psychodynamic groups within secondary mental health service. METHODS A naturalistic study (N = 103) with repeated assessments of process and clinical outcomes. Longitudinal statistics are linear mixed models. RESULTS The main PDs were avoidant, borderline and NOS PD, mean number of PDs 1.4(SD0.7), 60% females and mean initial age 38(SD10) years. Mean treatment duration was 1.5(SD 0.9) years. Therapist alliance and experienced group climate was satisfactory and stable. Improvements were significant (symptom distress, interpersonal problems, occupational functioning and additional mental health services), irrespective of general PD-severity, but not of PD-type, age or gender. The study demonstrates PD NOS benefits across all outcomes, occupational improvements for avoidant PD, despite prevailing symptoms, but generally poorer outcomes for males and age >38 years. For borderline PD, experienced conflict was stronger, treatment duration shorter and outcomes poor for early drop-outs (28%). CONCLUSION Psychodynamic group psychotherapy is a recommendable treatment for moderate PDs, which may address avoidant strategies, but may not meet clinical challenges of borderline PD. The outcome differences related to gender and age are noteworthy. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Norway.,Institute for Clinical Medicine, University of Oslo, Norway
| | - Ola Nordviste
- Student Health Service, Student Welfare Organization Oslo/Akershus, Norway
| | | | - Theresa Wilberg
- Institute for Clinical Medicine, University of Oslo, Norway.,Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Norway
| |
Collapse
|
19
|
Antonsen BT, Kvarstein EH, Urnes Ø, Hummelen B, Karterud S, Wilberg T. Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study. Psychother Res 2015; 27:51-63. [DOI: 10.1080/10503307.2015.1072283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
20
|
Karterud S. On Structure and Leadership in Mentalization-based Group Therapy and Group Analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/0533316415577339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mentalization-based group therapy (MBT-G) has its roots in group analytic psychotherapy. Modifications were made in order to suit the needs of more disturbed personality disordered patients, and to avoid the chaotic and destructive processes often encountered in groups dominated by these patients. In this article I outline the kind of leadership, structure and authority that MBT proscribes and discuss these principles in comparison with group analysis. I also comment upon a study of a MBT group that failed to establish a good mentalizing culture, with reference to Bion’s concept of ‘attack on linking’. This study reminds us that strong professional support and competent supervision is necessary in order to achieve sound communicational ideals, when the group is composed of members who easily resort to prementalistic modes of thinking.
Collapse
|
21
|
Sagen Inderhaug T, Karterud S. A Qualitative Study of a Mentalization-based Group for Borderline Patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/0533316415577341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article we present a video-based explorative study of three consecutive mentalization-based group therapy (MBT-G) sessions at a Norwegian Mental Health Centre. MBT-G has its roots in group analytic psychotherapy, but is modified to avoid the chaotic and destructive processes often encountered in groups consisting of severely personality disordered patients. Among the most notable differences from the Foulkesian group analytic approach are the therapists handling of authority and a ‘not-knowing stance’ (as opposed to an interpretative stance). Contrary to our expectations we found the typical chaotic borderline group processes that MBT-G was designed to avoid. An in-depth examination of the data, employing qualitative Thematic Analysis, revealed that the therapists failed to establish themselves as authoritative leaders of the group and misconstrued the ‘not-knowing stance’. We present transcripts of some typical sequences and discuss their clinical and therapeutic implications.
Collapse
|
22
|
Kvarstein EH, Pedersen G, Urnes Ø, Hummelen B, Wilberg T, Karterud S. Changing from a traditional psychodynamic treatment programme to mentalization-based treatment for patients with borderline personality disorder--does it make a difference? Psychol Psychother 2015; 88:71-86. [PMID: 25045028 PMCID: PMC4344810 DOI: 10.1111/papt.12036] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/12/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Few studies outside United Kingdom have documented effects of mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). This study aimed to investigate outcomes for BPD patients treated in an MBT programme in a Norwegian specialist treatment unit and compare benefits of the implemented MBT with the unit's former psychodynamic treatment programme. DESIGN A naturalistic, longitudinal, comparison of treatment effects for BPD patients before and after transition to MBT. METHODS The sample consisted of 345 BPD patients treated in the period 1993-2013. Before 2008, patients were admitted to a psychodynamic treatment programme (n = 281), after 2008 patients received MBT (n = 64). Symptom distress, interpersonal problems, and global functioning were assessed repeatedly throughout the treatment. Suicidal/self-harming acts, hospital admissions, medication, and occupational status were assessed at the start and end of treatment. Therapists' competence and adherence to MBT was rated and found satisfactory. The statistical method for longitudinal analyses was mixed models. RESULTS BPD patients in MBT and in the former psychodynamic treatment programme had comparable baseline severity and impairments of functioning. BPD patients in MBT had a remarkably low drop-out rate (2%), significantly lower than the former treatment. Improvements of symptom distress, interpersonal, global and occupational functioning were significantly greater for MBT patients. Large reductions in suicidal/self-harming acts, hospital admissions, and use of medication were evident in the course of both treatments. CONCLUSIONS The study confirms the effectiveness of MBT for BPD patients and indicates greater clinical benefits than in traditional psychodynamic treatment programmes. PRACTITIONER POINTS MBT is an effective treatment for patients with BPD. MBT can successfully be implemented in therapeutic settings outside United Kingdom and may be more beneficial than psychodynamic treatment programmes for BPD patients.
Collapse
Affiliation(s)
- Elfrida H Kvarstein
- Department of Personality Psychiatry, Clinic of Mental Health and Addiction, Oslo University HospitalOslo, Norway,*Correspondence should be addressed to Elfrida H. Kvarstein, Department of Personality Psychiatry, Clinic of Mental Health and Addiction, Oslo University Hospital, Postbox 4956 Nydalen, Oslo 0424, Norway ()
| | - Geir Pedersen
- Department of Personality Psychiatry, Clinic of Mental Health and Addiction, Oslo University HospitalOslo, Norway
| | - Øyvind Urnes
- Department of Personality Psychiatry, Clinic of Mental Health and Addiction, Oslo University HospitalOslo, Norway
| | - Benjamin Hummelen
- Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University HospitalOslo, Norway
| | - Theresa Wilberg
- Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University HospitalOslo, Norway
| | - Sigmund Karterud
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloNorway
| |
Collapse
|
23
|
Antonsen BT, Klungsøyr O, Kamps A, Hummelen B, Johansen MS, Pedersen G, Urnes Ø, Kvarstein EH, Karterud S, Wilberg T. Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC Psychiatry 2014; 14:119. [PMID: 24758722 PMCID: PMC4000615 DOI: 10.1186/1471-244x-14-119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy. METHODS The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses. RESULTS At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant. CONCLUSIONS The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment. TRIAL REGISTRATION NCT00378248.
Collapse
Affiliation(s)
| | - Ole Klungsøyr
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Kamps
- Department of Psychiatry, Lovisenberg Diaconal hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Merete S Johansen
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Urnes
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elfrida H Kvarstein
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sigmund Karterud
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway,Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
24
|
Black G, Murray J, Thornicroft G. Understanding the phenomenology of borderline personality disorder from the patient’s perspective. J Ment Health 2014; 23:78-82. [DOI: 10.3109/09638237.2013.869570] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
25
|
Gullestad FS, Johansen MS, Høglend P, Karterud S, Wilberg T. Mentalization as a moderator of treatment effects: Findings from a randomized clinical trial for personality disorders. Psychother Res 2013; 23:674-89. [DOI: 10.1080/10503307.2012.684103] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
26
|
|
27
|
Gullestad FS, Wilberg T, Klungsøyr O, Johansen MS, Urnes Ø, Karterud S. Is treatment in a day hospital step-down program superior to outpatient individual psychotherapy for patients with personality disorders? 36 months follow-up of a randomized clinical trial comparing different treatment modalities. Psychother Res 2012; 22:426-41. [DOI: 10.1080/10503307.2012.662608] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
28
|
|
29
|
Barnicot K, Katsakou C, Marougka S, Priebe S. Treatment completion in psychotherapy for borderline personality disorder: a systematic review and meta-analysis. Acta Psychiatr Scand 2011; 123:327-38. [PMID: 21166785 DOI: 10.1111/j.1600-0447.2010.01652.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Psychotherapy for borderline personality disorder (BPD) has been associated with problematically low treatment completion rates. METHOD PsycInfo and Medline were systematically searched to identify studies providing information on treatment completion in psychotherapy models that have been shown to be effective for BPD. A meta-analysis of treatment completion rates and a narrative analysis of factors predicting dropout were conducted. RESULTS Forty-one studies were included, with completion rates ranging from 36% to 100%- a substantial between-study heterogeneity. Random effects meta-analyses yielded an overall completion rate of 75% (95% CI: 68-82%) for interventions of <12 months duration, and 71% (95% CI: 65-76%) for longer interventions. Egger's test for publication bias was significant for both analyses (P ≤ 0.01). Study characteristics such as treatment model and treatment setting did not explain between-study heterogeneity. In individual studies, factors predicting dropout status included commitment to change, the therapeutic relationship and impulsivity, whilst sociodemographics were consistently non-predictive. CONCLUSION Borderline personality disorder should no longer be associated with high rates of dropout from treatment. However, the substantial variation in completion rates between studies remains unexplained. Research on the psychological processes involved in dropping out of treatment could further improve dropout rates.
Collapse
Affiliation(s)
- K Barnicot
- Unit for Social and Community Psychiatry, Queen Mary, University of London, UK.
| | | | | | | |
Collapse
|
30
|
Larivière N, Boyer R. [Revisiting the therapeutic experience in a psychiatric day hospital six months after discharge: path and perceptions of people with mental disorders]. SANTE MENTALE AU QUEBEC 2011; 36:75-97. [PMID: 21983906 DOI: 10.7202/1005815ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article presents a qualitative study on the therapeutic experience in a psychiatric day hospital six months after discharge. The study explores the impact of this experience on the lives of people with mental disorders. A qualitative design using semi-structured individual interviews was completed with 18 participants six months after their discharge of a day hospital. Results showed that the day hospital experience was particularly helpful to improve symptoms and relationship with self. It activated a self-transformational process that continued afterwards. Termination created for many, an abrupt void. Issues at stake during the first six months were continuity of care, social support and maintaining skills and knowledge acquired.
Collapse
Affiliation(s)
- Nadine Larivière
- École de Réadaptation, Université de Sherbrooke, Centre Affilié Universitaire CSSS-IUGS, Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine
| | | |
Collapse
|
31
|
Abstract
Approximately one third of day hospitals in Europe can be designated as predominantly psychotherapeutic. They address mainly patients with personality disorders (PD), but also eating disorders and chronic mood and anxiety disorders without PD. As day treatment programmes tend to become associated with mental health centers, their treatment intensity also tends to become reduced. Available data suggest that approximately 10 hours of treatment a week is sufficient. Is such treatment more effective than specialized outpatient treatment? This research question will probably set the agenda in the years to come. In response to this challenge, day treatment should become more specialized. Data from the Norwegian Network of Psychotherapeutic Day Hospitals (n = 2.205) demonstrate that the majority of day treatment patients suffer from borderline and avoidant PD. Programmes for patients with borderline PD are well developed. The authors call for programme development for patients with avoidant PD.
Collapse
Affiliation(s)
- Sigmund Karterud
- Department for Personality Psychiatry, Psychiatric Division, Ullevål University Hospital, Oslo, Norway.
| | | |
Collapse
|