Top

Cognitive Therapy and Research

Gepubliceerd in:

31-10-2020 | Original Article

Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study

Auteurs: María V. Navarro-Haro, Verónica Guillén Botella, Laura Badenes-Ribera, Luis Borao, Azucena García-Palacios

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2021

Abstract

Background

Dialectical Behavior Therapy (DBT) has shown evidence of its effectiveness in the treatment of borderline personality disorder (BPD) and eating disorders (EDs) separately, and there is preliminary evidence for co-occurrent BPD and EDs. However, the long-term effectiveness of DBT for this specific population is still unknown. The main goal of this study was to assess long-term treatment effectiveness in people diagnosed with BPD and ED.

Methods

Participants (N = 109) had previously received a 6-month treatment during a clinical trial (DBT = 64 vs. Treatment as Usual, Cognitive Behavior Therapy; TAU CBT = 45). Outcome measures (emotional eating, depressive symptoms, anger, emotion regulation, impulsiveness, and resilience) were evaluated prospectively at 4- and 6-year follow-ups.

Results

There was a statistically significant improvement in most study outcomes from pre-treatment to the follow-ups in the DBT condition, and in depression, resilience and trait anger in the TAU CBT. No statistically significant between-group differences were found. Nonetheless, a high percentage of participants showed a clinically significant improvement over time in the DBT condition.

Conclusions

Findings of this study contribute to determinate the long-term treatment effectiveness of DBT for people with BPD and ED in routine psychotherapeutic practice. Longitudinal studies with larger sample sizes are needed to confirm these results.

vorige artikel An Analysis of the Pattern of Adaptive Emotion Regulation Associated with Low Paranoid Ideation in Healthy and Clinical Samples

volgende artikel The Impact of Moral-Based Appraisals on Psychological Outcomes in Response to Analogue Trauma: An Experimental Paradigm of Moral Injury

Aasen, H. (2001). An empirical investigation of depression symptoms: norms, psychometric characteristics and factor structure of the Beck Depression Inventory-II. Bergen, Norway: The University of Bergen.

Allison, P. D. (2001). Missing data. Thousand Oaks, CA: Sage.

Álvarez-Tomás, I., Soler, J., Bados, A., Martín-Blanco, A., Elices, M., Carmona, C., et al. (2017). Long-term course of borderline personality disorder: a prospective 10-year follow-up study. Journal of Personality Disorders, 31(5), 590–605.PubMed

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.) Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Association.

Arnow, B., Kenardy, J., & Agras, W. S. (1995). The emotional eating scale: the development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18(1), 79–90.

Bankoff, S., Karpel, M., Forbes, H., & Pantalone, D. (2012). A systematic review of dialectical behavioral therapy for eating disorders. Eating Disorders, 20, 196–215.PubMed

Barratt, E. S. (1995). Impulsiveness and aggression. Chicago: The University of Chicago Press.

Barratt, R. D., Orozco-Cabal, L. F., & Moeller, F. G. (2004). Impulsivity and sensation seeking: a historical perspective on current challenges. On the psychobiology of personality: essays in honor of Marvin Zuckerman (pp. 3–17). Amsterdam: Elsevier Science.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II. Beck depression inventory-second edition manual. San Antonio, TX: The Psychological Corporation.

Ben-Porath, D., Duthu, F., Luo, T., Gonidakis, F., Compte, E. J., & Wisniewski, L. (2020). Dialectical behavioral therapy: An update and review of the existing treatment models adapted for adults with eating disorders. Eating Disorders, 28(2), 101–121.PubMed

Ben-Porath, D. D., Wisniewski, L., & Warren, M. (2009). Differential treatment response for eating disordered patients with and without a comorbid borderline personality diagnosis using a dialectical behavior therapy (DBT)-informed approach. Eating Disorders, 17, 225–241.PubMed

Brassington, J., & Krawitz, R. (2006). Australasian dialectical behaviour therapy pilot outcome study: effectiveness, utility and feasibility. Australasian Psychiatry, 14(3), 313–319.PubMed

Cabello, R., Salguero, J. M., Fernández-Berrocal, P., & Gross, J. J. (2013). A Spanish adaptation of the Emotion Regulation Questionnaire. European Journal of Psychological Assessment, 29, 234–240.

Campbell-Sills, L., Cohan, S. L., & Stein, M. B. (2006). Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behaviour Research and Therapy, 44(4), 585–599.PubMed

Carmona, C., Pascual, J. C., Elices, M., Navarro, H., Martin, B. A., & Soler, J. (2018). Factors predicting early dropout from dialectical behaviour therapy in individuals with borderline personality disorder. ActasEspañolas de Psiquiatria, 46(6), 226–233.

Chen, E., Brown, M., Harned, M., & Linehan, M. M. (2009). A comparison of borderline personality disorder with and without eating disorders. Psychiatry Research, 170, 86–90.PubMedPubMedCentral

Chen, Y., & Safer, L. (2010). Dialectical behavior therapy for bulimia nervosa and binge-eating disorder. In C. M. Grilo & J. E. Mitchell (Eds.), The treatment of eating disorders: a clinical handbook (pp. 294–317). New York: The Guildford Press.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum Associates.

Collins, L. M., Schafer, J. L., & Kam, C. M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6, 330–351.PubMed

Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory. Psychological Bulletin, 135, 495–510.PubMedPubMedCentral

Diemen, L. V., Szobot, C. M., Kessler, F., & Pechansky, F. (2007). Adaptation and construct validation of the Barratt Impulsiveness Scale (BIS 11) to Brazilian Portuguese for use in adolescents. Brazilian Journal of Psychiatry, 29, 153–156.

Distel, M. A., Middeldorp, C. M., Trull, T. J., Derom, C. A., Willemsen, G., & Boomsma, D. I. (2011). Life events and borderline personality features: the influence of gene–environment interaction and gene–environment correlation. Psychological Medicine, 41(4), 849–860.PubMed

Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): an example of the troublesome ‘Not Otherwise Specified’ (NOS) category in DSM-IV. Behaviour Research and Therapy, 43, 691–701.PubMedPubMedCentral

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for DSM-IV axis I disorders, Clinician Version (SCID-CV). Washington, D.C.: American Psychiatric Press Inc.

First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis II personality disorders, (SCID-II). Washington, D.C.: American Psychiatric Press Inc.

Fruzzetti, A. E., & Shenk, C. E. (2020). Fostering validating responses in families. In P. D. Hoffman & P. Steiner-Grossman (Eds.), Borderline personality disorder: meeting the challenges to successful treatment (pp. 215–228). London: Routledge.

Gail, W., & Heather, Y. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1(2), 165–177.

García-Palacios. (2005). BPD Clinical Data Inventory [Unpublished Manuscript]. Universidad Jaume I, Castellón, Spain.

Garner, D. M., Vitousek, K., & Pike, K. M. (1997). Cognitive-behavioral therapy for anorexia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2nd ed., pp. 94–174). New York: Guilford Press.

Graham, J. W. (2009). Missing data analysis: making it work in the real world. Annual Review of Psychology, 60, 549–576.PubMed

Graham, J. W., Olchowski, A. E., & Gilreath, T. D. (2007). How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prevention Science, 8, 206–213.PubMed

Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.PubMed

Gunderson, J., Stout, R., McGlashan, T., Shea, M., Morey, L., Grilo, C., et al. (2011). Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of General Psychiatry, 68(8), 827–837.PubMedPubMedCentral

Hardt, J., Herke, M., & Leonhart, R. (2012). Auxiliary variables in multiple imputation in regression with missing X: a warning against including too many in small sample research. BMC Medical Research Methodology, 12, 184–196.PubMedPubMedCentral

Hunt, M., Auriemma, J., & Cashaw, A. (2003). Self-report bias and underreporting of depression on the BDI-II. Journal of Personality Assessment, 80, 26–30.PubMed

Iglesias, E. B., Durán, A. L., & del Río, E. F. (2013). Resiliencia y consumo de cannabis, drogas de síntesis y cocaína en jóvenes. PsicopatologíaClínica Legal y Forense, 13(1), 59–72.

Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.PubMed

Kröger, C., Schweiger, U., Sipos, V., Kliem, S., Arnold, R., Schunert, T., & Reinecker, H. (2010). Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up. Journal of Behavior Therapy and Experimental Psychiatry, 41(4), 381–388.PubMed

Lazarus, R. S., & Alfert, E. (1964). Short-circuiting of threat by experimentally altering cognitive appraisal. The Journal of Abnormal and Social Psychology, 69(2), 195–205.

Lenz, A. S., Taylor, R., Fleming, M., & Serman, N. (2014). Effectiveness of dialectical behavior therapy for treating eating disorders. Journal of Counseling and Development, 92(1), 26–35.

Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.

Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. New York: Guilford Press.

Linehan, M. M. (2003). Manual de tratamiento de los trastornos de personalidadlímite. Barcelona: Paidós.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.PubMed

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA psychiatry, 72(5), 475–482.PubMed

López-Montoyo, A., & Cebolla i Martí, A. J. (2016). Comer por aburrimiento: relación entre tendencia al aburrimiento y estilos de ingesta en población general. Agora de Salut III, 3, 227–234.

Martinussen, M., Friborg, O., Schmierer, P., Kaiser, S., Øvergård, K. T., Neunhoeffer, A. L., et al. (2017). The comorbidity of personality disorders in eating disorders: a meta-analysis. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 22(2), 201–209.

Masten, A. S. (2001). Ordinary magic: resilience processes in development. American Psychologist, 56, 227–238.

McMain, S. F., Guimond, T., Barnhart, R., Habinski, L., & Streiner, D. L. (2017). A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiatrica Scandinavica, 135(2), 138–148.PubMed

McMain, S. F., Guimond, T., Streiner, D. L., Cardish, R. J., & Links, P. S. (2012). Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry, 169(6), 650–661.

Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., et al. (2018). Dialectical behavior therapy in the treatment of borderline personality disorder and eating disorders comorbidity: a pilot study in a naturalistic setting. Cognitive Therapy and Research, 42, 636–649.

Navarro-Haro, M. V., Wessman, I., Botella, C., & García-Palacios, A. (2015). The role of emotion regulation strategies and dissociation in non-suicidal self-injury for women with borderline personality disorder and comorbid eating disorder. Comprehensive Psychiatry, 63, 123–130.PubMed

Neacsiu, A. D., Bohus, M., & Linehan, M. M. (2014). Dialectical behavior therapy: An intervention for emotion dysregulation. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 491–507). New York: Guilford Press.

Neill, J. T., & Dias, K. L. (2001). Adventure education and resilience: The double-edged sword. Journal of Adventure Education and Outdoor Learning, 1(2), 35–42.

Newton, J. R. (2019). Borderline personality disorder and eating disorders: a trans-diagnostic approach to unravelling diagnostic complexity. Australasian Psychiatry, 27(6), 556–558.PubMed

Oquendo, M. A., Baca-Garcia, E., Graver, R., Morales, M., & Montalvan, V. (2001). Spanish adaptation of the Barratt impulsiveness scale (BIS-11). The European Journal of Psychiatry, 15(3), 147–155.

Paris, J., Perlin, J., Laporte, L., Fitzpatrick, M., & DeStefano, J. (2014). Exploring resilience and borderline personality disorder: a qualitative study of pairs of sisters. Personality and Mental Health, 8(3), 199–208.PubMed

Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.PubMed

Perpiñá, C., Cebolla, A., Botella, C., Lurbe, E., & Torró, M.I. (2011). Emotional eating scale for children and adolescents: psychometric characteristics in a Spanish sample. Journal of Clinical Child & Adolescent Psychology, 40, 3, 424–33.

Reivich, K., & Shatte, A. (2002). The resilience factor: 7 keys to finding your inner strength and overcoming life’s hurdles. New York: Three Rivers Press.

Rosenthal, M. Z., Gratz, K. L., Kosson, D. S., Cheavens, J. S., Lejuez, C. W., & Lynch, T. R. (2008). Borderline personality disorder and emotional responding: a review of the research literature. Clinical Psychology Review, 28, 75–91.PubMed

Safer, D. L., Robinson, A. H., & Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy, 41, 106–120.PubMedPubMedCentral

Safer, L., Telch, C., & Chen, Y. (2017). Dialectical behavior therapy for binge eating and bulimia. New York: The Guildford Press.

Salvo, L., & Castro, A. (2013). Confiabilidad y validez de la escala de impulsividad de Barratt (BIS-11) en adolescentes. Revista chilena de neuro-psiquiatría, 51(4), 245–254.

Sanz, J., García Vera, M.P., Espinosa, R., Fortún, M. & Vázquez, C. (2005). Adaptación española del Inventario para la Depresión de Beck-II (BDI-II): 3. Propiedades psicométricas en pacientes con trastornos psicológicos. Clínica y Salud. Investigación Empírica en Psicología, 16(2), 121–42.

Sanz, J., Navarro, M. E., & Vázquez, C. (2003). Adaptaciónespañola del inventario para la depresión de Beck-II (BDI-II): 1. Propiedadespsicométricas en estudiantesuniversitarios. Análisis y Modificación de Conducta, 29, 239–288.

Schulze, L., Domes, G., Krüger, A., Berger, C., Fleischer, M., Prehn, K., et al. (2011). Neuronal correlates of cognitive reappraisal in borderline patients with affective instability. Biological Psychiatry, 69(6), 564–573.PubMed

Soler, J., Pascual, J. C., Campins, J., Barrachina, J., Puigdemont, D., Alvarez, E., & Pérez, V. (2005). Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder. American Journal of Psychiatry, 162(6), 1221–1224.

Spielberger, C. D. (1999). Manual for the state-trait anger expression inventory-2. Odessa, FL: Psychological Assessment Resources.

Stanford, M. S., Mathias, C. W., Dougherty, D. M., Lake, S. L., Anderson, N. E., & Patton, J. H. (2009). Fifty years of the Barratt impulsiveness scale: an update and review. Personality and Individual Differences, 47(5), 385–395.

Stoffers, J., Völl, B. A., Rücker, G., Timmer, A., Huband, N. & Lieb, K. (2010). Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews: CD005653.

Stoffers, J.M., Völlm, B.A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2, CD005652.

Tabachnick, B., & Fidell, L. (2007). Using multivariate statistics. New York: Harper Collins.

Tobal, J., Casado, M., Cano, A., & Spielberger, C. (2001). Manual inventario de expresión de iraestado—rasgo 2. Madrid: TEA Ediciones.

Treasure, J. L., & Schmidt, U. (2002). Anorexia nervosa. Clinical Evidence, 8, 903–913.

van Ginkel, J. R., Linting, M., Rippe, R. C. A., & van der Voort, A. (2020). Rebutting existing misconceptions about multiple imputation as a method for handling missing data. Journal of Personality Assessment, 102, 3, 297–308.

Wagnild, G. M., & Young, H. (1993). Development and psychometric. Journal of nursing measurement, 1(2), 165–17847.PubMed

Waller, G., & Osman, S. (1998). Emotional eating and eating psychopathology among non eating-disordered women. International Journal of Eating Disorders, 23, 419–424.

Wilson, T. G., Fairburn, C. G., & Agras, S. (1997). Cognitive-behavioural therapy for bulimia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (pp. 67–93). New York: Guilford Press.

Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. M. (2016). Fluidity of the subsyndromal phenomenology of borderline personality disorder over 16 years of prospective follow-up. American Journal of Psychiatry, 173(7), 688–694.

Zanarini, M. C., Reichman, C. A., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). The course of eating disorders in patients with borderline personality disorder: A 10-year follow-up study. The International Journal of Eating Disorders, 43(3), 226–232.PubMedPubMedCentral

Titel: Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study
Auteurs: María V. Navarro-Haro
Verónica Guillén Botella
Laura Badenes-Ribera
Luis Borao
Azucena García-Palacios
Publicatiedatum: 31-10-2020
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 3/2021
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-020-10170-9

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Background

Methods

Results

Conclusions

Log in om toegang te krijgen

Andere artikelen Uitgave 3/2021

Cognitive Therapy in the Treatment and Prevention of Depression: A Fifty-Year Retrospective with an Evolutionary Coda

The Impact of Moral-Based Appraisals on Psychological Outcomes in Response to Analogue Trauma: An Experimental Paradigm of Moral Injury

Cognitive-Behavioral Therapy for Envy

Attention Deployment to the Eye Region of Emotional Faces among Adolescents with and without Social Anxiety Disorder

Couples’ Diminished Social and Financial Capital Exacerbate the Association Between Maladaptive Attributions and Relationship Satisfaction

How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment