RESUMEN
BACKGROUND: Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS: The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION: The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION: Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
Asunto(s)
Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Trastorno de Personalidad Limítrofe/psicología , Terapia Conductual Dialéctica/métodos , Humanos , Estudios Multicéntricos como Asunto , Psicoterapia/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapia de Esquemas , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and uncertainty is a reduced accessibility of meaning ('semantic satiation'). METHODS: OCD patients (n = 24) and matched non-clinical controls (n = 24) repeated words 2 (non-perseveration) or 20 times (perseveration). They decided whether this word was related to another target word. Speed of relatedness judgments and feelings of dissociative uncertainty were measured. The effects of real-life perseveration on dissociative uncertainty were tested in a smaller subsample of the OCD group (n = 9). RESULTS: Speed of relatedness judgments was not affected by perseveration. However, both groups reported more dissociative uncertainty after perseveration compared to non-perseveration, which was higher in OCD patients. Patients reported more dissociative uncertainty after 'clinical' perseveration compared to non-perseveration.. LIMITATIONS: Both parts of this study are limited by some methodological issues and a small sample size. CONCLUSIONS: Although the mechanism behind 'perseveration â uncertainty' is still unclear, results suggest that the effects of perseveration are counterproductive.
Asunto(s)
Trastornos Disociativos/psicología , Trastorno Obsesivo Compulsivo/psicología , Incertidumbre , Adulto , Estudios de Casos y Controles , Trastornos Disociativos/complicaciones , Femenino , Humanos , Masculino , Trastorno Obsesivo Compulsivo/complicaciones , Adulto JovenRESUMEN
Repeated checking leads to reductions in meta-memory (i.e., memory confidence, vividness and detail), and automatization of checking behavior (Dek, van den Hout, Giele, & Engelhard, 2014, 2015). Dek et al. (2014) suggested that this is caused by increased familiarity with the checked stimuli. They predicted that defamiliarization of checking by modifying the perceptual characteristics of stimuli would cause de-automatization and attenuate the negative meta-memory effects of re-checking. However, their results were inconclusive. The present study investigated whether repeated checking leads to automatization of checking behavior, and if defamiliarization indeed leads to de-automatization and attenuation of meta-memory effects in patients with OCD and healthy controls. Participants performed a checking task, in which they activated, deactivated and checked threat-irrelevant stimuli. During a pre- and post-test checking trial, check duration was recorded and a reaction time task was simultaneously administered as dual-task to assess automatization. After the pre- and post-test checking trial, meta-memory was rated. Results showed that relevant checking led to automatization of checking behavior on the RT measure, and negative meta-memory effects for patients and controls. Defamiliarization led to de-automatization measured with the RT task, but did not attenuate the negative meta-memory effects of repeated checking. Clinical implications are discussed.
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Automatismo/complicaciones , Automatismo/psicología , Conducta Compulsiva/complicaciones , Conducta Compulsiva/psicología , Memoria , Trastorno Obsesivo Compulsivo/complicaciones , Trastorno Obsesivo Compulsivo/psicología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Tiempo de Reacción , Reconocimiento en Psicología , Adulto JovenRESUMEN
Individuals with obsessive-compulsive disorder (OCD) exhibit perseverative behaviours, like checking, to reduce uncertainty, but perseveration paradoxically enhances uncertainty. It is unclear what mechanism might be responsible. We hypothesised that perseverative OC-like behaviour produces "semantic satiation" and interferes with the accessibility of meaning. Healthy participants repeated 20 types of OC-like checking behaviour nonperseveratively (2 times) or perseveratively (20 times). Afterwards, they decided as quickly as possible whether a picture was semantically related to the checked object. The nonperseverative condition showed spreading of activation: Judgements were faster for related than for unrelated objects and pictures. The effect was blocked in the perseverative condition, where reaction times for related and unrelated items were similar. The results suggest that the ironic effects of compulsive perseveration are due to interference with spreading of activation.
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Conducta Compulsiva/psicología , Trastorno Obsesivo Compulsivo/psicología , Análisis de Varianza , Femenino , Humanos , Masculino , Tiempo de Reacción/fisiología , Adulto JovenRESUMEN
Several studies have found that making eye movements while retrieving visual images about past negative events reduces their vividness and emotional intensity. A working memory account states that eye movements tax working memory and interfere with visual imagery, thus degrading images. This study examined whether eye movements also affect recurrent, intrusive visual images about potential future catastrophes ("flashforwards") in a sample of female undergraduates who had indicated on a screening-scale that they suffer from such intrusions. They were asked to recall two intrusive images with or without making eye movements. Before and after each condition, participants retrieved the image, and rated its vividness and emotionality. Results showed that vividness of intrusive images was lower after recall with eye movement, relative to recall only, and there was a similar trend for emotionality. Potential implications are discussed.
Asunto(s)
Atención , Desensibilización y Reprocesamiento del Movimiento Ocular , Memoria a Corto Plazo , Trastornos por Estrés Postraumático/terapia , Análisis de Varianza , Emociones , Femenino , Humanos , Imaginación , Masculino , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/psicología , Adulto JovenRESUMEN
When obsessive-compulsive (OC) patients are confronted with disorder-relevant situations, they tend to reason in chains of small steps between the current situation and a highly improbable catastrophe. It was hypothesized that this type of "perseverative reasoning" would increase the subjective likelihood of the feared catastrophe. In an experiment with 63 healthy undergraduates, we tested whether OC-like perseverative reasoning induces feelings of uncertainty about a harmful outcome and makes this outcome more credible. Furthermore, we explored whether making multiple series of events increases these effects. Participants were administered a neutral situation with a catastrophic improbable outcome. In a pre- and post-test, they rated the credibility of this outcome and feelings of uncertainty about the outcome. In between, two experimental groups were instructed to generate respectively one or five series of intermediate steps between the situation and the harmful outcome, while a control group carried out a filler task. Consistent with the predictions, perseverative reasoning enhanced the credibility of a negative, improbable outcome. However, there were no differences between the two experimental conditions (one or five reasoning chains), and perseverative reasoning did not increase uncertainty about the outcome. The OC-like generation of small steps between an innocuous situation and a negative outcome increases the credibility of a feared outcome, potentially serving to maintain obsessive-compulsive disorder (OCD) problems.
Asunto(s)
Trastorno Obsesivo Compulsivo/psicología , Solución de Problemas , Incertidumbre , Humanos , Probabilidad , Desempeño PsicomotorRESUMEN
Repeated checking to reduce memory distrust seems to be counterproductive: it increases memory distrust. Obsessive-compulsive (OC) patients tend to be uncertain about other cognitive domains as well, like attention and perception. In an experiment with 70 healthy participants, we tested whether perseverative checking induces distrust not only in memory, but also in attention and perception. Participants were administered a computer task in which they had to activate, deactivate, and check threat-irrelevant stimuli, and rate their confidence in memory, attention, and perception in a pre-test and post-test. In between these tests, the relevant checking group performed 20 checks of the same stimuli used in the pre- and post-test. The irrelevant checking group performed 20 checks of different stimuli. Although memory accuracy improved in both groups, repeated checking reduced confidence in memory, vividness, and detail in the relevant checking group, but not in the irrelevant checking group. A trend was found towards a decline in attentional confidence in the relevant checking group only. Perception was not affected by repetitive checking. A replication study revealed similar results of relevant checking on meta-memory, however, the trend for attentional distrust was not confirmed. The results suggest that perseveration may be domain specific, i.e., only the cognitive processes that are subject to perseveration are affected.
Asunto(s)
Atención , Memoria , Percepción , Confianza/psicología , Adolescente , Adulto , Análisis de Varianza , Computadores , Femenino , Humanos , Masculino , Recuerdo Mental , Pruebas Psicológicas , Adulto JovenRESUMEN
Repeated and compulsive-like checking reduces confidence in memory for the last check. Obsessive-compulsive (OC) patients are not only uncertain about memory, but may also be uncertain about perception, while this perceptual uncertainty may be associated with prolonged visual fixation on the object of uncertainty. It was reported earlier that, among healthy participants, prolonged staring at light bulbs or gas rings induces OC-like uncertainty about perception and feelings of dissociation [van den Hout, M. A., Engelhard, I. M., de Boer, C., du Bois, A., & Dek, E. (2008). Perseverative and compulsive-like staring causes uncertainty about perception. Behaviour Research and Therapy, 46, 1300-1304]. In that study, staring continued for 10min. For patients, however, staring intervals seem to be considerably shorter. To test the clinical credibility of the paradigm as a model of the maintenance of OC perceptual uncertainty, we investigated whether the effects of staring materialize long before 10min. Five groups of 16 undergraduates participated: one group did not stare at a gas stove while the others stared for 7.5, 15, 30 or 300s. In the absence of staring, no pre-to-post increase in dissociation/uncertainty was reported, but after staring it was. The larger part of the observed dissociation/uncertainty after 5min had occurred within 30s, and around 50% of this maximal increase was reported between 7.5 and 15s. Thus, even relatively short intervals of staring induce uncertainty about perception and dissociative experiences. Perseverative looking at objects may be a counter-productive OC strategy, which increases uncertainty about perception and may serve to maintain the disorder.