RESUMEN
Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for borderline personality disorder (BPD), with findings demonstrating improvements in various BPD features and related behaviours, such as nonsuicidal self-injury (NSSI). Theory and research suggest that reductions in emotion dysregulation and interpersonal dysfunction could account for at least some of the reduction in NSSI observed during the course of DBT. The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and NSSI over the course of DBT, and 2) whether changes in emotion dysregulation mediate the relationship between changes in interpersonal dysfunction and changes in NSSI over treatment. One hundred and twenty individuals with BPD enrolled in a multi-site randomized-clinical trial were assessed at five timepoints over 12 months of standard DBT. Results indicated that interpersonal dysfunction and NSSI decreased over the course of DBT. Emotion dysregulation decreased in a quadratic manner such that most of the gains in emotion dysregulation occurred in earlier phases of DBT. Although changes in interpersonal dysfunction predicted changes in emotion dysregulation, changes in emotion dysregulation did not mediate the relationship between changes in interpersonal dysfunction and changes in NSSI.
Asunto(s)
Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Regulación Emocional , Relaciones Interpersonales , Conducta Autodestructiva , Humanos , Trastorno de Personalidad Limítrofe/terapia , Trastorno de Personalidad Limítrofe/psicología , Conducta Autodestructiva/psicología , Conducta Autodestructiva/terapia , Femenino , Adulto , Masculino , Regulación Emocional/fisiología , Adulto Joven , Resultado del Tratamiento , Adolescente , Persona de Mediana EdadRESUMEN
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.
Asunto(s)
Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Conducta Autodestructiva , Humanos , Trastorno de Personalidad Limítrofe/psicología , Resultado del Tratamiento , Conducta Autodestructiva/terapia , Conducta Autodestructiva/psicología , Listas de Espera , Terapia ConductistaRESUMEN
Despite nearly 30 years of research demonstrating its effectiveness in the treatment of borderline personality disorder (BPD) and related problems, few studies have investigated mechanisms of change for dialectical behavior therapy (DBT; Linehan, 1993a). Improvements in mindfulness and emotion regulation have been highlighted as key potential mechanisms of change in DBT (Lynch et al., 2006). The present study examined the time course of and associations between mindfulness, emotion regulation, and BPD symptoms during DBT. Participants were 240 repeatedly and recently self-harming adults (Mage = 27.75) with BPD who were randomly assigned to receive either 6 or 12 months of standard DBT. Primary hypotheses were that: (a) changes in mindfulness would occur before changes in emotion regulation, and (b) changes in emotion regulation would mediate the association of changes in mindfulness with changes in BPD symptoms. Results from changepoint analysis illuminated the proportion of participants for whom first changes occurred in emotion regulation (40.7%), mindfulness (32.4%), or both (26.9%). Contrary to hypotheses, five-wave, cross-lagged analyses did not indicate mediational effects of either mindfulness or emotion regulation on the association of either variable with change in BPD symptoms. Supplemental analyses, however, suggested that changes in emotion regulation mediated the inverse association of changes in mindfulness with changes in BPD symptoms. Findings highlight patterns of change in key, proposed mechanisms of change in DBT and suggest important future research directions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Asunto(s)
Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Regulación Emocional , Atención Plena , Adulto , Humanos , Trastorno de Personalidad Limítrofe/terapia , Trastorno de Personalidad Limítrofe/psicología , Terapia Conductista/métodos , Resultado del TratamientoRESUMEN
The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians' recommendations for providing DBT via telehealth. Participants included N =â¯99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians' attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.
Asunto(s)
COVID-19 , Terapia Conductual Dialéctica , Telemedicina , Femenino , Masculino , Humanos , Pandemias , AutocuidadoRESUMEN
Borderline personality disorder (BPD) is characterized by instability in interpersonal, affective, cognitive, self-identity, and behavioral domains. For a BPD diagnosis, individuals must present at least five of nine symptoms, resulting in 256 possible symptom combinations; thus, individuals diagnosed with BPD can differ substantially. Specific symptoms of BPD tend to co-occur, suggesting BPD subgroups. To explore this potential, we analyzed data from 504 participants diagnosed with BPD enrolled in one of three randomized controlled trials conducted at center for Addiction and Mental Health in Toronto, Canada from 2002 to 2018. An exploratory latent class analysis (LCA) was conducted to identify symptom subgroups of BPD. Analyses indicated three latent subgroups. The first group (n = 53) is distinguished by a lack of affective instability and low levels of dissociative symptoms (non-labile type). The second group (n = 279) is characterized by high levels of dissociative and paranoid symptoms but low abandonment fears and identity disturbance (dissociative/paranoid type). The third group (n = 172) is characterized by high efforts to avoid abandonment and interpersonal aggression (interpersonally unstable type). Homogenous symptom subgroups of BPD symptoms exist and may have important implications for how to refine BPD treatment interventions.
Asunto(s)
Trastorno de Personalidad Limítrofe , Humanos , Trastorno de Personalidad Limítrofe/psicología , Análisis de Clases Latentes , Agresión , Salud Mental , Trastornos Disociativos/psicologíaRESUMEN
The growing use of digitized mental health applications requires new reliable early screening tools to identify user suicide risk. We used a lexicon-based random forest machine learning algorithm to predict suicide ideation scores from 714 online community text posts from December 2019 to April 2020. We validated predicted scores against expert-rated suicide ideation scores. The algorithm-predicted scores offered high validity and a low error rate and correctly identified 95% of expert-rated high-risk suicide ideation posts. Our findings highlight a potential new method to detect suicidal ideation of digital mental health application users.
Asunto(s)
Salud Mental , Ideación Suicida , Humanos , Bosques Aleatorios , Factores de RiesgoRESUMEN
INTRODUCTION: Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. OBJECTIVE: The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. METHODS: This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (N = 240, M (SD)age = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. RESULTS: The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = -1.94, Mdiff [95% CI] = 0.16 [-0.14, 0.46]; 12 months: margin = -1.47, Mdiff [95% CI] = 0.04 [-0.17, 0.23]; 24 months: margin = -1.25, Mdiff [95% CI] = 0.12 [-0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. CONCLUSIONS: The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.
Asunto(s)
Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Conducta Autodestructiva , Femenino , Humanos , Adulto , Masculino , Terapia Conductual Dialéctica/métodos , Trastorno de Personalidad Limítrofe/terapia , Derivación y Consulta , Teléfono , Psicoterapia/métodos , Conducta Autodestructiva/terapia , Resultado del Tratamiento , Terapia Conductista/métodosRESUMEN
OBJECTIVES: Emotional and interpersonal dysfunction appears central to nonsuicidal self-injury (NSSI), yet research examining the interplay of these factors among individuals with NSSI is limited. This study aimed to specify such associations before and after daily stressful events among individuals with (vs. without) NSSI. METHODS: Young adult participants (Mage = 20.4) with past-year (n = 56) or no history (n = 47) of NSSI completed daily diary assessments over a 2-week period. RESULTS: No differences in rates of positive or negative interpersonal experiences before or after stressful events were identified. NSSI participants, however, reported greater negative emotion following stressful events compared with non-NSSI participants. The presence (vs. absence) of a positive interpersonal experience following a stressful event was related to lower negative emotional responses only in the NSSI group. CONCLUSION: Positive interpersonal experiences may downregulate negative emotions following stressful events among individuals with NSSI, highlighting the potential relevance of interpersonal emotion regulation to this population.
Asunto(s)
Conducta Autodestructiva , Adulto , Emociones , Humanos , Conducta Autodestructiva/psicología , Adulto JovenRESUMEN
INTRODUCTION: People report multiple motives for nonsuicidal self-injury (NSSI), but few studies have examined how these motives relate to one another. This study identified person-centered classes of NSSI motives, their NSSI and psychopathological correlates, and their utility in predicting future NSSI across two samples. METHODS: Participants were adolescents and young adults (aged 15-35) with recent NSSI recruited from online forums (n = 155, Sample 1) or the community (n = 127, Sample 2). Participants completed measures of NSSI, emotion regulation difficulties, borderline personality disorder (BPD), depression, and reported on their NSSI over 12 months. RESULTS: Latent profile analyses yielded five classes in each sample: low interpersonal, self-punishment/interpersonal, moderate intra/interpersonal, high intra/interpersonal, and mainly interpersonal motives. Classes were not associated with lifetime NSSI characteristics, but highly motivated participants reported more severe depression and BPD symptoms, and greater emotion dysregulation than low-motivated participants. Those in the mainly interpersonal (Sample 1) and self-punishment/interpersonal (Sample 2) motives classes reported greater NSSI frequency during follow-up. CONCLUSIONS: This study identified five classes of NSSI motives. Participants who report multiple motives for NSSI may be more clinically severe, whereas those who report strong desires to communicate with others or punish themselves may be at the highest risk for more frequent NSSI over time.
Asunto(s)
Trastorno de Personalidad Limítrofe , Conducta Autodestructiva , Adolescente , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/psicología , Humanos , Motivación , Psicopatología , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/psicología , Adulto JovenRESUMEN
OBJECTIVE: Behavioral models of nonsuicidal self-injury (NSSI) propose that experiencing desirable consequences following NSSI reinforces the behavior. However, these models do not specify whether experiencing more desirable consequences relative to other people (between-person), an individual's own average (within-person), or both, predicts NSSI severity. To address this gap, this study investigated the prospective, within- and between-person associations of desirable NSSI consequences with NSSI frequency (number of episodes) and versatility (number of methods). METHODS: Two hundred and ten individuals (93.81% female, Mage = 22.95) with a history of NSSI completed online surveys assessing NSSI consequences, frequency, and versatility every three months for one year. RESULTS: Within-person increases in desirable emotional consequences were unrelated to NSSI frequency three months later but predicted increases in NSSI versatility. Within-person increases in desirable social consequences predicted decreases in NSSI frequency three months later but were unrelated to NSSI versatility. Between-person variability in desirable consequences was unrelated to NSSI severity. CONCLUSIONS: Findings were partially consistent with behavioral models of NSSI. Going forward, we recommend that: (1) behavioral models articulate the salience of within-person fluctuations in consequences; (2) research clarifies the role of social consequences; and (3) clinicians use repeated assessments of emotional consequences to identify periods of elevated NSSI risk.
Asunto(s)
Conducta Autodestructiva , Humanos , Femenino , Adulto Joven , Adulto , Masculino , Estudios Prospectivos , Conducta Autodestructiva/psicología , Relaciones Interpersonales , Emociones , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Although once considered a defining feature of borderline personality disorder, research has found high rates of NSSI among individuals with other psychiatric disorders, particularly posttraumatic stress disorder (PTSD) and depressive disorders. A recent study from our research team found that lifetime PTSD and depressive disorders were associated with unique self-reported NSSI motives. Given well-established limitations of assessing motives via self-report measures, the present study sought to extend this line of research by using a novel laboratory measure of the implicit NSSI-relief association to examine NSSI emotional relief motives. METHOD: A subset of participants from our previous study (N = 109) completed diagnostic interviews and the laboratory-based DSH-Relief Implicit Association Test (IAT). RESULTS: Findings indicated that individuals with lifetime PTSD evidenced stronger NSSI-relief associations than those without PTSD. Further, this main effect was qualified by a PTSD by depressive disorder interaction, such that stronger NSSI-relief associations were found among individuals with lifetime PTSD but no lifetime depressive disorder than among individuals without a history of either PTSD or a depressive disorder. CONCLUSIONS: Results highlight the importance of investigating NSSI motives associated with different symptom profiles using a multi-method approach.
Asunto(s)
Trastorno de Personalidad Limítrofe , Trastorno Depresivo , Conducta Autodestructiva , Trastornos por Estrés Postraumático , Trastorno de Personalidad Limítrofe/psicología , Humanos , Motivación , Conducta Autodestructiva/psicología , Trastornos por Estrés Postraumático/psicologíaRESUMEN
BACKGROUND: Despite theories that negative reinforcement in the form of relief from negative emotions maintains nonsuicidal self-injury (NSSI), no studies have examined the extent to which specific emotional consequences of NSSI predict the maintenance of NSSI over time or explain the greater risk for NSSI found among individuals with borderline personality disorder (BPD) pathology. This study examined whether specific emotional consequences of NSSI relate to the continuance of NSSI behavior over a 12-month period and explain the relation of baseline BPD pathology to future NSSI. METHODS: Participants with a history of recent repeated NSSI (N = 84) completed baseline measures of BPD pathology, NSSI, and the emotional antecedents and consequences of NSSI, including self-conscious emotions, undifferentiated negative affect, anger, emptiness, sadness, and anxiety; follow-up data on NSSI were collected every three months for one year. RESULTS: Of the emotional consequences of NSSI examined here, only self-conscious emotions significantly predicted the presence and frequency of NSSI during the 12-month follow-up period. Likewise, whereas BPD pathology was not directly associated with later NSSI, both overall BPD pathology and the specific BPD feature of identity problems were indirectly related to the presence of 12-month NSSI through the greater frequency of post-NSSI self-conscious emotions. LIMITATIONS: Emotional consequences of NSSI were assessed using a retrospective self-report measure. Only frequency, and not intensity, of emotions before and after NSSI were assessed. CONCLUSIONS: Results suggest a distinct role of post-NSSI self-conscious emotions in the maintenance of NSSI among individuals with and without BPD pathology.
Asunto(s)
Trastorno de Personalidad Limítrofe , Conducta Autodestructiva , Emociones , Humanos , Estudios Retrospectivos , AutoinformeRESUMEN
Individuals with borderline personality disorder (BPD) often experience deficits in social role functioning, which encompasses the ability to adhere to socially defined rules and norms of behaviour. Additionally, research suggests that coping styles influence the way individuals with BPD manage stress and that symptom presentation and functioning in individuals with BPD vary across genders. This study sought to explore these variables via moderated mediation, investigating the mediating influence of coping styles on the association between BPD symptoms and social role dysfunction and if these associations were further moderated by gender. Participants (N = 233) were outpatients attending a programme for personality dysfunction. Participants completed measures of BPD symptoms, coping styles and social role dysfunction. Moderated mediation indicated that for women, emotion-oriented coping and social diversion-oriented coping mediated the association between BPD symptoms and social dysfunction. While BPD symptoms were positively associated with emotion coping, which was positively associated with social role dysfunction, BPD symptoms were negatively associated with social diversion coping, which was negatively associated with social role dysfunction. For men, coping did not mediate the association between BPD symptoms and social role dysfunction. Our findings may indicate that social support and a healthy social network may play an important part in the ongoing social role functioning of women with BPD. From this, potential early therapeutic interventions targeting safe social engagement in times of stress may decrease the pervasive and persistent nature of social dysfunction in BPD. © 2020 John Wiley & Sons, Ltd.
Asunto(s)
Adaptación Psicológica/fisiología , Trastorno de Personalidad Limítrofe/fisiopatología , Emociones/fisiología , Funcionamiento Psicosocial , Rol , Red Social , Habilidades Sociales , Apoyo Social , Adulto , Humanos , Persona de Mediana Edad , Factores SexualesRESUMEN
Borderline personality disorder (BPD) is a disorder characterized by emotion regulation (ER) difficulties. Although research indicates that patterns of ER differ across racial groups, few studies have examined the role of race in the ER-BPD association. This study sought to address this gap. Participants in this study identified as either East Asian, White, or Black, and were recruited from sites in Western Canada and the Southern United States. Two samples were included in this study: (a) 194 university students who self-reported BPD features and (b) 88 adults from the community who underwent diagnostic interviews and had a BPD diagnosis. All participants self-reported ER difficulties. Results revealed that race moderated the link between some aspects of ER difficulties and BPD. For instance, relations between (a) nonacceptance of emotions and BPD affect instability, (b) limited access to ER strategies and BPD identity disturbance, and (c) low emotional awareness and BPD diagnosis were stronger among White (vs. Black or East Asian) participants. Implications of these findings for the diagnosis and treatment of BPD across racial groups are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Asunto(s)
Trastorno de Personalidad Limítrofe/psicología , Regulación Emocional , Factores Raciales , Adulto , Pueblo Asiatico/psicología , Población Negra/psicología , Canadá , Femenino , Humanos , Masculino , Autoinforme , Estados Unidos , Población Blanca/psicología , Adulto JovenRESUMEN
Borderline personality disorder (BPD) is a severe and complex disorder characterized by instability across many life domains, including interpersonal relations, behavior, and emotions. A core feature and contributor to BPD, emotion dysegulation (ED), consists of deficits in the ability to regulate emotions in a manner that allows the individual to pursue important goals or behave effectively in various contexts. Biosocial developmental models of BPD have emphasized a transaction of environmental conditions (e.g., invalidating environments and adverse childhood experiences) with key genetically linked vulnerabilities (e.g., impulsivity and emotional vulnerability) in the development of ED and BPD. Emerging evidence has begun to highlight the complex, heterotypic pathways to the development of BPD, with key heritable vulnerability factors possibly interacting with aspects of the rearing environment to produce worsening ED and an adolescent trajectory consisting of self-damaging behaviors and eventual BPD. Adults with BPD have shown evidence of a variety of cognitive, physiological, and behavioral characteristics of ED. As the precursors to the development of ED and BPD have become clearer, prevention and treatment efforts hold great promise for reducing the long-term suffering, functional impairment, and considerable societal costs associated with BPD.
Asunto(s)
Trastorno de Personalidad Limítrofe/psicología , Emociones/fisiología , Conducta Impulsiva/fisiología , Relaciones Interpersonales , HumanosRESUMEN
BACKGROUND: Nonsuicidal self-injury (NSSI) is highly prevalent among adolescent and emerging adult females. Most studies examining the relationship between stress and NSSI largely have relied on aggregate self-report measures of stress and between-person models. Using data from two prospective samples, this manuscript tests the hypothesis that within-person models of NSSI provide better clinical markers of risk for NSSI than between-person models of NSSI. METHODS: Two samples (Sample 1: 220 high-risk girls, M age = 14.68, SD = 1.36, baseline assessment and 3-month follow-ups for 18 months; Sample 2: 40 emerging adult females with a history of NSSI, M age = 21.55, SD = 2.14, 14 days with daily retrospective reports) were followed prospectively and completed validated measures of stress and NSSI. Models were adjusted for age and depression. RESULTS: In Sample 1, a within-person model demonstrated that higher-than-usual (but not average) stress levels predicted NSSI within the same 3-month wave. In Sample 2, results from a within-person model with daily diary assessment data showed that higher-than-usual stress (but not average daily stress) predicted same-day NSSI. CONCLUSIONS: Together, our results suggest that higher-than-usual stress, relative to one's typical stress level, but not average stress levels, signals times of enhanced risk for NSSI. These results highlight the clinical utility of repeated assessments of stress.
Asunto(s)
Conducta Autodestructiva/epidemiología , Estrés Psicológico/epidemiología , Adolescente , Adulto , Femenino , Humanos , Estudios Prospectivos , Adulto JovenRESUMEN
Theories of borderline personality disorder (BPD) highlight the central role of emotional dysfunction in this disorder, with a particular emphasis on emotional reactivity and emotion regulation (ER) difficulties. However, research on emotion-related difficulties in BPD has produced mixed results, often related to the particular indices of emotional responding used in the studies. As such, the specific nature of emotional dysfunction in BPD, as well as the extent to which subjective emotion-related difficulties map onto corresponding physiological deficits, remains unclear. This study examined both subjective and physiological indices of emotional reactivity and ER difficulties in response to a social rejection emotion induction (relative to a neutral emotion induction) across three groups of participants: self-harming young adults with BPD, self-harming young adults without BPD, and clinical controls with no self-harm history or BPD. Consistent with the hypotheses, results revealed a lack of convergence between subjective and physiological indices of emotional reactivity and ER difficulties among participants with BPD. Whereas participants with BPD reported both greater emotional reactivity and greater ER difficulties in response to the negative emotion induction than participants without self-harm or BPD, there were no significant differences in physiological indices of emotional reactivity or ER between participants with BPD and either of the control groups. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Síntomas Afectivos/fisiopatología , Trastorno de Personalidad Limítrofe/fisiopatología , Regulación Emocional/fisiología , Distancia Psicológica , Conducta Autodestructiva/fisiopatología , Adolescente , Adulto , Trastorno de Personalidad Limítrofe/epidemiología , Comorbilidad , Femenino , Humanos , Masculino , Conducta Autodestructiva/epidemiología , Adulto JovenRESUMEN
Extant research has supported a connection between socialization in childhood and difficulties regulating emotions. The biosocial theory of borderline personality disorder (BPD; Crowell, Beauchaine, & Linehan, 2009; Linehan, 1993) suggests that emotion dysregulation is a core mechanism underlying the extreme behaviors, mood instability, identity disturbance, and relationship instability observed in BPD. The present study investigated the impact of socialization factors related to emotions, parental autonomy support, parental psychological control, and childhood trauma on BPD features in a nonclinical young adult sample (N = 357). Relationships between socialization factors and BPD features were evaluated using structural equation modeling, to test integrative hypotheses informed by biosocial theory and self-determination theory. We found that recalled experiences of childhood trauma, emotional magnification of negative emotions, neglect of negative emotions, and parental psychological control were positively associated with BPD features. Difficulties regulating emotions mediated the relationships of childhood emotion socialization factors and psychological control with BPD features. Implications for future research, resiliency, and intervention are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Experiencias Adversas de la Infancia , Autoritarismo , Trastorno de Personalidad Limítrofe/fisiopatología , Regulación Emocional/fisiología , Relaciones Padres-Hijo , Autonomía Personal , Trauma Psicológico , Socialización , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
OBJECTIVE: We used a daily diary to examine (1) the frequency of three types of NSSI thoughts and urges (fleeting thoughts, persistent thoughts, and intense urges), (2) the correlates of NSSI thought and urges within and across days, (3) strategies that aid in resisting NSSI thoughts and urges, and (4) the prospective association of daily NSSI thoughts and urges with NSSI behavior over 12 months. METHOD: Sixty adults (aged 18-35) completed a two-week daily diary and follow-ups every 3 months for one year. RESULTS: Fleeting NSSI thoughts were reported on 48% of days, whereas persistent thoughts (11%) and intense urges (17%) were less common. Within days, earlier stress predicted more persistent NSSI thoughts, whereas earlier perceived support predicted less intense NSSI urges. Furthermore, NSSI thoughts and urges were positively associated with same-day stress and avoidant coping. Problem-focused coping was associated with greater success resisting same-day fleeting thoughts and intense urges, as well as success resisting next-day persistent thoughts. Perceived support was associated with less intense same-day urges, but also less success resisting these urges. Over the follow-up, persistent thoughts predicted less frequent NSSI, whereas intense urges predicted more frequent NSSI. CONCLUSIONS: NSSI thoughts and urges are commonly experienced and deserve further attention.
Asunto(s)
Adaptación Psicológica , Autocontrol , Conducta Autodestructiva , Adulto , Femenino , Humanos , Inhibición Psicológica , Masculino , Estudios Prospectivos , Sistemas de Apoyo Psicosocial , Conducta Autodestructiva/prevención & control , Conducta Autodestructiva/psicologíaRESUMEN
BACKGROUND: Although Dialectical Behaviour Therapy (DBT) is an evidence-based psychosocial treatment for borderline personality disorder (BPD), the demand for it exceeds available resources. The commonly researched 12-month version of DBT is lengthy; this can pose a barrier to its adoption in many health care settings. Further, there are no data on the optimal length of psychotherapy for BPD. The aim of this study is to examine the clinical and cost-effectiveness of 6 versus 12 months of DBT for chronically suicidal individuals with BPD. A second aim of this study is to determine which patients are as likely to benefit from shorter treatment as from longer treatment. METHODS/DESIGN: Powered for non-inferiority testing, this two-site single-blind trial involves the random assignment of 240 patients diagnosed with BPD to 6 or 12 months of standard DBT. The primary outcome is the frequency of suicidal or non-suicidal self-injurious episodes. Secondary outcomes include healthcare utilization, psychiatric and emotional symptoms, general and social functioning, and health status. Cost-effectiveness outcomes will include the cost of providing each treatment as well as health care and societal costs (e.g., missed work days and lost productivity). Assessments are scheduled at pretreatment and at 3-month intervals until 24 months. DISCUSSION: This is the first study to directly examine the dose-effect of psychotherapy for chronically suicidal individuals diagnosed with BPD. Examining both clinical and cost effectiveness in 6 versus 12 months of DBT will produce answers to the question of how much treatment is good enough. Information from this study will help to guide decisions about the allocation of scarce treatment resources and recommendations about the benefits of briefer treatment. TRIAL REGISTRATION: NCT02387736 . Registered February 20, 2015.