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3Let op het is Open Access maar met speciale Elsevier user rights, zie https://www.elsevier.com/about/policies/open-access-licenses/elsevier-user-license Background The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Methods The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics). Results In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309). Limitations The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time. Conclusions Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patient's coping skills with regard to anger.
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This special theme issue of the Journal of Clinical Psychology: In Session, edited by Dr. Suzanne Haeyen and Dr. Giancarlo Dimaggio, is devoted to arts and psychomotor therapies in patients with personality disorders (PD). The issue starts with an introduction and concludes with a commentary by the guest editors. The content of the special issue consists of seven papers, each based on a clinical case coming from different modalities, countries and continents. The papers focus on therapeutic working methods from the arts, dance movement, drama, music therapies and body based/psychomotor therapy with the aim of personal development, finding an appropriate therapeutic entrance, coping with grief, post traumatic nightmares, personal integration, interpersonal functioning and making meaning of one’s own life story in words and images. The case studies cover people diagnosed with various PDs such as narcissistic, dependent and borderline PD, in mental health care and forensic settings. With these case descriptions, we offer a multicolored palette of possibilities, knowing that there is so much more to know and explore.
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PURPOSE: To test if a collaborative care program (CCP) with nurses in a coordinating position is beneficial for patients with severe personality disorders. DESIGN AND METHODS: A pilot study with a comparative multiple case study design using mixed methods investigating active ingredients and preliminary results. FINDINGS: Most patients, their informal caregivers, and nurses value (parts of) the CCP positively; preliminary results show a significant decrease in severity of borderline symptoms. PRACTICE IMPLICATIONS: With the CCP,we may expand the supply of available treatments for patients with (severe) personality disorders, but a larger randomized controlled trial is warranted to confirmour preliminary results.
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Purpose To examine the factors that influence the effective execution of a collaborative care program (CCP) for patients with severe personality disorders. Design and Methods A multiple case study using qualitative research methods. Findings Three factors were identified as influencing the execution process: (a) the context in which the CCP was executed, (b) the patient population, and (c) the individual application of the CCP by nurses. +Practice Implications The prominent position of mental health nurses in complex intervention programs such as CCPs poses new challenges for them in making these programs work. A CCP could be a useful intervention for patients with severe personality disorders because it offers the necessary structure in treatment.
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Art therapy is widely used and effective in the treatment of patients diagnosed with Personality Disorders (PDs). Current psychotherapeutic approaches may benefit from this additional therapy to improve their efficacy. But what is the patient perspective upon this therapy? This study explored perceived benefits of art therapy for patients with PDs to let the valuable perspective of patients be taken into account. Using a quantitative survey study over 3 months (N = 528), GLM repeated measures and overall hierarchical regression analyses showed that the majority of the patients reported quite a lot of benefit from art therapy (mean 3.70 on a 5-point Likert scale), primarily in emotional and social functioning. The improvements are concentrated in specific target goals of which the five highest scoring goals affected were: expression of emotions, improved (more stable/positive) self-image, making own choices/autonomy, recognition of, insight in, and changing of personal patterns of feelings, behaviors and thoughts and dealing with own limitations and/or vulnerability. Patients made it clear that they perceived these target areas as having been affected by art therapy and said so at both moments in time, with a higher score after 3 months. The extent of the perceived benefits is highly dependent for patients on factors such as a non-judgmental attitude on the part of the therapist, feeling that they are taken seriously, being given sufficient freedom of expression but at the same time being offered sufficient structure and an adequate basis. Age, gender, and diagnosis cluster did not predict the magnitude of perceived benefits. Art therapy provides equal advantages to a broad target group, and so this form of therapy can be broadly indicated. The experienced benefits and the increase over time was primarily associated with the degree to which patients perceive that they can give meaningful expression to feelings in their artwork. This provides an indication for the extent of the benefits a person can experience and can also serve as a clear guiding principle for interventions by the art therapist.
DOCUMENT
Background: Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP’s as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design: Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews) will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the ‘black box’ of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion: The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients.
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"Purpose: Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach: The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings: Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications: These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value: The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders."
DOCUMENT
Arts and psychomotor therapies are often part of the multidisciplinary treatment for people diagnosed with Personality Disorders (PDs). Drama therapy is aimed at promoting emotion regulation and strengthening of interpersonal skills. The added value of drama therapy has not been sufficiently examined and available studies only provide indirect client reports. Hence, we focus on what people with PDs perceive as effects of drama therapy. This qualitative study followed the Grounded Theory Approach utilising indepth, semi-structured interviews in a natural drama therapy context. Interviews were held with 19 people diagnosed with PDs, who were purposefully sampled. They were recruited from five treatment centres, with five drama therapists involved. Interviews were transcribed verbatim and analysed using a three-step approach: open, axial, and selective coding. Open coding resulted in 93 codes. In the coding process, four overarching themes came to the fore: allowing playfulness and its inherent benefits, connecting the inner and outer emotional world, understanding of maladaptive coping styles, and intrapersonal and interpersonal behavior change. The perceived effects as reported by people diagnosed with PDs provide information about what drama therapy means to them, in their daily lives and which aspects of the treatment were most valuable to them. This study contributes to the necessary underpinning of drama therapy.
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People with personality disorders (PDs) are often difficult to reach emotionally in therapy. As music therapy (MT) provides an entry point to emotions and facilitates contact and communication, it is regularly used with this target group. This study presents a case study of a 40-year-old woman diagnosed with a PD not otherwise defined. “Nina” experienced depressive and physical symptoms, including severe anxiety. Previous treatments had failed. In MT, she experienced a sense of safety. Over the course of the treatment, she experimented with making herself heard, learned to listen to herself and recognize her own physical signals, permitted closeness and cooperation, and began setting boundaries and taking initiative. She got in touch with and learned to regulate emotions such as sadness and fear. Self-criticism gave way to a more compassionate self. Nina began to experience positive feelings and showed progress in her work and social interactions. The findings suggest that MT can directly connect to clients' emotions, behaviors, and thoughts in a way they perceive as safe. This is of the utmost importance for clients who are hard to reach. The use of MT can potentially prevent dropout and further entrapment in personality problems.
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Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co‐creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, “An Empowering Story” and life‐story‐focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long‐term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self‐compassion, and meaning making. She developed self‐reflection and integration of internal conflicts leading to a better emotional balance and self‐understanding. Art therapy emphasizes bottom‐up regulatory processes, while narrative psychology supports top‐down regulatory processes. The combined approach effectively integrated bottom‐up, experiential, sensory experiences with top‐down, cognitive emotion‐regulation processes. The results suggest that psychotherapeutic interventions involving a multi‐pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders
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