Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention
Abstract Background Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-12-01
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| Series: | Borderline Personality Disorder and Emotion Dysregulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40479-022-00204-x |
| _version_ | 1797980213136588800 |
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| author | Joaquim Soler Elisabet Casellas-Pujol Juan Carlos Pascual Carlos Schmidt Elisabet Domínguez-Clavé Ausias Cebolla David Alvear Anna Muro Matilde Elices |
| author_facet | Joaquim Soler Elisabet Casellas-Pujol Juan Carlos Pascual Carlos Schmidt Elisabet Domínguez-Clavé Ausias Cebolla David Alvear Anna Muro Matilde Elices |
| author_sort | Joaquim Soler |
| collection | DOAJ |
| description | Abstract Background Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. Methods This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. Results The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. Conclusions The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD. |
| first_indexed | 2024-04-11T05:52:01Z |
| format | Article |
| id | doaj.art-3b21538bdc024242a91909e8b5e57649 |
| institution | Directory Open Access Journal |
| issn | 2051-6673 |
| language | English |
| last_indexed | 2024-04-11T05:52:01Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Borderline Personality Disorder and Emotion Dysregulation |
| spelling | doaj.art-3b21538bdc024242a91909e8b5e576492022-12-22T04:42:03ZengBMCBorderline Personality Disorder and Emotion Dysregulation2051-66732022-12-019111410.1186/s40479-022-00204-xAdvancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills interventionJoaquim Soler0Elisabet Casellas-Pujol1Juan Carlos Pascual2Carlos Schmidt3Elisabet Domínguez-Clavé4Ausias Cebolla5David Alvear6Anna Muro7Matilde Elices8Department of Psychiatry, Hospital de la Santa Creu i Sant PauDepartment of Psychiatry, Hospital de la Santa Creu i Sant PauDepartment of Psychiatry, Hospital de la Santa Creu i Sant PauDepartment of Psychiatry, Hospital de la Santa Creu i Sant PauDepartment of Psychiatry, Hospital de la Santa Creu i Sant PauDepartamento de Personalidad, Evaluación y Tratamientos Psicológicos, University of Valencia UVUniversidad del País Vasco/Euskal Herriko UnibertsitateaUniversitat Autònoma de Barcelona (UAB)Institut d’Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMAbstract Background Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. Methods This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. Results The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. Conclusions The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.https://doi.org/10.1186/s40479-022-00204-xBorderline personality disorderLong-lasting BPDFeasibilityAcceptabilitySkills trainingPositive psychology |
| spellingShingle | Joaquim Soler Elisabet Casellas-Pujol Juan Carlos Pascual Carlos Schmidt Elisabet Domínguez-Clavé Ausias Cebolla David Alvear Anna Muro Matilde Elices Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention Borderline Personality Disorder and Emotion Dysregulation Borderline personality disorder Long-lasting BPD Feasibility Acceptability Skills training Positive psychology |
| title | Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention |
| title_full | Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention |
| title_fullStr | Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention |
| title_full_unstemmed | Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention |
| title_short | Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention |
| title_sort | advancing the treatment of long lasting borderline personality disorder a feasibility and acceptability study of an expanded dbt based skills intervention |
| topic | Borderline personality disorder Long-lasting BPD Feasibility Acceptability Skills training Positive psychology |
| url | https://doi.org/10.1186/s40479-022-00204-x |
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