Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Effectiveness of dialectic-behavioral skills training based on Soler model alone and along with family education in reduction of borderline personality disorder symptoms with three months follow up

https://doi.org/10.14412/2074-2711-2023-1-50-56

Abstract

High prevalence of borderline personality disorder, high comorbidity with other psychiatric disorders, impulsive reactions necessitate psychological interventions on this group of patients.
Objective: this study aimed to indicate the effect of dialectical behavior therapy individually and along with family therapy on borderline personality symptoms.
Materials and methods. Eight patients were selected based on diagnostic and statistical manual of mental disorders (DSM-5), borderline personality disorder severity Index (BPDSI) and semi-structural interview (SCID-II). They divided into two groups: individual intervention and individual intervention with family education. All received Soler-based dialectical behavioral skills training (3-months) in 13 sessions of 120 minutes. In four stages, beginning of sessions, the median of treatment, end of the treatment, and three months after treatment, BPDSI questionnaire were filled and family of the second group completed McMaster questionnaire.
Results. The findings of Friedman test show the effectiveness of dialectic-behavioral skills training based on Soler model as a short-term model alone and along with family education in reducing the symptoms of borderline personality disorder. Wilcoxon test indicate the effectiveness of this method in reducing the symptoms in post-test. Three months follow-up indicates the stability of the results with a 95% confidence level. U Mann-Whitney indicates no significant difference between two groups.
Conclusion. Dialectical-behavior skills training based on the Soler model is effective in reducing the symptoms of borderline personality disorder and improving family function. It is recommended as a short term method to control the symptoms of borderline personality disorder and improvement the performance and communication among family members.

About the Authors

A. Safarzadeh
Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences
Islamic Republic of Iran

Atiyeh Safarzadeh

1985717443 Tehran, Velenjak St., Shahid Chamran Highway, Yas Educational Complex, Fourth Floor, Taleghani General Hospital


Competing Interests:

There are no conflicts of interest.



M. Bakhtiari
Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences
Islamic Republic of Iran

1985717443 Tehran, Velenjak St., Shahid Chamran Highway, Yas Educational Complex, Fourth Floor, Taleghani General Hospital


Competing Interests:

There are no conflicts of interest.



M. R. Shaeiri
Department of Psychology, Shahed University
Islamic Republic of Iran

3319118651 Tehran, opposite Holy shrine of Imam Khomeini, Khalij Fars Expressway


Competing Interests:

There are no conflicts of interest.



A. Kheradmand
Department of Psychiatry, Shahid Beheshti University of Medical Sciences
Islamic Republic of Iran

1983535511 Tehran, Daneshjoo Blvd, Evin Ave, School of Medicine


Competing Interests:

There are no conflicts of interest.



M. Saberihaji
Department of Social Medicine, Baqiyatallah University of Medical Sciences
Islamic Republic of Iran

1435916471 Tehran, Sheikh Bahaie South St., Mulla Sadra St., Vanak Square


Competing Interests:

There are no conflicts of interest.



References

1. Kulacaoglu F, Kose S. Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain Sci. 2018 Nov 18;8(11):201. doi:10.3390/brainsci8110201

2. Schmahl C, Herpertz SC, Bertsch K, et al. Mechanisms of disturbed emotion processing and social interaction in borderline personality disorder: state of knowledge and research agenda of the German Clinical Research Unit. Borderline Personal Disord Emot Dysregul. 2014 Sep 9;1:12. doi:10.1186/2051-6673-1-12

3. Brickman LJ, Ammerman BA, Look AE, et al. The relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college sample. Borderline Personal Disord Emot Dysregul. 2014 Sep 25;1:14. doi:10.1186/2051-6673-1-14. eCollection 2014.

4. Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1993 Dec;50(12):971-4. doi:10.1001/archpsyc.1993.01820240055007

5. Linehan M. Skills training manual for treating borderline personality disorder: New York: Guilford Press; 1993.

6. Linehan MM, Armstrong HE, Suarez A, et al. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991 Dec;48(12):1060-4. doi:10.1001/archpsyc.1991.01810360024003

7. May JM, Richardi TM, Barth KS. Dialectical behavior therapy as treatment for borderline personality disorder. Ment Health Clin. 2016 Mar 8;6(2):62-67. doi:10.9740/mhc.2016.03.62. eCollection 2016 Mar.

8. Westad YAS, Hagen K, Jonsbu E, Solem S. Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy. Front Psychol. 2021 Feb 26;12:578230. doi:10.3389/fpsyg.2021.578230. eCollection 2021.

9. Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-40. doi:10.1007/s10608-012-9476-1. Epub 2012 Jul 31.

10. McMain SF, Chapman AL, Kuo JR, et al. The effectiveness of 6 versus 12-months of dialectical behaviour therapy for borderline personality disorder: the feasibility of a shorter treatment and evaluating responses (FASTER) trial protocol. BMC Psychiatry. 2018 Jul 17;18(1):230. doi:10.1186/s12888-018-1802-z

11. Soler J, Pascual JC, Tiana T, et al. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behav Res Ther. 2009 May;47(5):353-8. doi:10.1016/j.brat.2009.01.013. Epub 2009 Jan 29.

12. Storebo OJ, Stoffers-Winterling JM, Völlm BA, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020 May 4;5(5):CD012955. doi:10.1002/14651858.CD012955.pub2

13. Davarani ZZ, Heydarinasab L. The effectiveness of dialectical behavior therapy skills to reduction in difficulty in emotion regulation among students. Revista Argentina de Clinica Psicologica. 2019;28(5):842.

14. Livesley WJ, Dimaggio G, Clarkin JF. Why integrated treatment?: General principles of therapeutic change. Integrated treatment for personality disorder: A modular approach. New York, NY, US: The Guilford Press; 2016. P. 3-18.

15. Choi-Kain LW, Finch EF, Masland SR, et al. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007/s40473-017-0103-z. Epub 2017 Feb 3.

16. Livesley WJ. Moving beyond specialized therapies for borderline personality disorder: the importance of integrated domain-focused treatment. Psychodyn Psychiatry. 2012 Mar;40(1):47-74. doi:10.1521/pdps.2012.40.1.47

17. Livesley WJ. Integrated treatment: A conceptual framework for an evidence-based approach to the treatment of personality disorder. J Pers Disord. 2012 Feb;26(1):17-42. doi:10.1521/pedi.2012.26.1.17

18. Guile JM, Boissel L, Alaux-Cantin S, de La Riviere SG. Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies. Adolesc Health Med Ther. 2018 Nov 23;9:199-210. doi:10.2147/AHMT.S156565. eCollection 2018.

19. Hoffman PD, Fruzzetti AE. Advances in interventions for families with a relative with a personality disorder diagnosis. Curr Psychiatry Rep. 2007 Feb;9(1):68-73. doi:10.1007/s11920-007-0012-z

20. Gunderson JG. Handbook of good psychiatric management for borderline personality disorder. American Psychiatric Pub; 2014.

21. Taghizadeh M, Ghorbani T, Saffarinia M. Effectiveness of Emotion Regulation Techniques of Dialectical Behavior Therapy on Emotion Regulation Strategies in Women with Borderline Personality Disorder and Substance Abuse Disorder: Multiple Baseline Design. Res Psychol Health. 2015;9(3):66-73.

22. Loveless JP, Whited MC, Rhodes AC, Cellucci T. The Blending of Evidenced-Based Protocols in the Treatment of Borderline Personality Disorder: A Case Study. Clin Case Stud. 2016;15(5):392-408.

23. Linehan MM. DBT Skills Training Manual. 2<sup>nd</sup> ed. The Guilford Press; 2015.

24. Linehan MM. DBT Skills Training Handouts and Worksheets. 2<sup>nd</sup> ed. New York: The Guilford Press; 2015.

25. Salavati M. Maladaptive Schemas and efficacy of schema therapy in patients with borderline Borderline personality Disorders. Tehran: Iran University of Medical Scienecs; 2007.

26. Mohammadkhani P, Jokar M, Jahani-Tabesh O, Tamannaei-Far S. Structured clinical interview for DSM-IV axis II personality disorders (Persian Version). Tehran: Danjeh; 2011.

27. Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Family Ther. 1983;9(2):171-80.

28. Beyrami M, Farnam A, Gholizadeh H, Imani M. Depressed patient's family functionings, a study based on McMaster model. Med J Tabriz Univ Med Sci. 2010;23(2).

29. Zadehmohammadi A, Malek Khosravi G. The Preliminary Study of Psychometric and Reliability of Family Assessment Device. J Family Res. 2006;2(5).

30. Fruzzetti AE, Santisteban DA, Hoffman PD. Dialectical behavior therapy with families. 2007.

31. Soler J, Pascual JC, Tiana T, et al. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behav Res Ther. 2009 May;47(5):353-8. doi:10.1016/j.brat.2009.01.013. Epub 2009 Jan 29.

32. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav Res Ther. 2010 Sep;48(9):832-9. doi:10.1016/j.brat.2010.05.017. Epub 2010 May 23.

33. Stepp SD, Epler AJ, Jahng S, Trull TJ. The effect of dialectical behavior therapy skills use on borderline personality disorder features. J Pers Disord. 2008 Dec;22(6):549-63. doi:10.1521/pedi.2008.22.6.549

34. Kliem S, Kröger C, Kosfelder J. Dialectical Behavior Therapy for Borderline Personality Disorder: A Meta-Analysis Using MixedEffects Modeling. J Consult Clin Psychol. 2010 Dec;78(6):936-51. doi:10.1037/a0021015

35. Neacsiu AD, Lungu A, Harned MS, Rizvi SL, Linehan MM. Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder. Behav Res Ther. 2014 Feb;53:47-54. doi:10.1016/j.brat.2013.12.004. Epub 2013 Dec 19.

36. Van Goethem A, Mulders D, Muris M, et al. Reduction of self-injury and improvement of coping behavior during dialectical behaviour therapy (DBT) of patients with borderline personality disorder. Int J Psychology Psychol Ther. 2012;12(1):21-34.

37. Vogelzang E. DBT-A and Parental Inclusion in Skills Training Groups. 2017.

38. APA. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). 5th ed. American Psychiatric Association Publishing; 2013. 991 p.

39. Landucci J, Foley GN. Couples Therapy: Treating Selected Personality-disordered Couples Within a Dynamic Therapy Framework. Innov Clin Neurosci. 2014;11(3-4):29-36.

40. Leppänen V, Kärki A, Saariaho T, et al. Changes in schemas of patients with severe borderline personality disorder: the Oulu BPD study. Scand J Psychol. 2015 Feb;56(1):78-85. doi:10.1111/sjop.12172. Epub 2014 Oct 30.


Review

For citations:


Safarzadeh A, Bakhtiari M, Shaeiri MR, Kheradmand A, Saberihaji M. Effectiveness of dialectic-behavioral skills training based on Soler model alone and along with family education in reduction of borderline personality disorder symptoms with three months follow up. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(1):50-56. https://doi.org/10.14412/2074-2711-2023-1-50-56

Views: 897


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)