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The unified protocol for anxiety and depression with comorbid borderline personality disorder: a single case design clinical series

Published online by Cambridge University Press:  31 July 2019

Michelle E. Lopez Open the ORCID record for Michelle E. Lopez [Opens in a new window] ,
Steven R. Thorp ,
Matthew Dekker ,
Andrew Noorollah ,
Giovanna Zerbi ,
Laura A. Payne ,
Emily Meier  and
Jill A. Stoddard
Michelle E. Lopez*
Affiliation:
California School of Professional Psychology at Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
Steven R. Thorp
Affiliation:
California School of Professional Psychology at Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
Matthew Dekker
Affiliation:
California School of Professional Psychology at Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
Andrew Noorollah
Affiliation:
California School of Professional Psychology at Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
Giovanna Zerbi
Affiliation:
University of California, San Diego, 1899 McKee Street, Ste 126, San Diego, CA 92110, USA
Laura A. Payne
Affiliation:
Pediatric Pain Program, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 22-464 MDCC, Los Angeles, CA 90095-1752, USA
Emily Meier
Affiliation:
University of California, San Diego, 9500 Gilman Drive 0664, La Jolla, CA 92093-0664, USA
Jill A. Stoddard
Affiliation:
California School of Professional Psychology at Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
*
*Corresponding author. Email: DrMichelleLopez@gmail.com
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Abstract

This study used a single case experimental design to investigate the use of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) among a sample of individuals with depression and anxiety who also presented with borderline personality disorder (BPD). Eight women received individual treatment with the UP over the course of 14–16 treatment sessions, and were assessed for anxiety and depression severity on a weekly basis over a 2–6 week baseline period and throughout treatment. Three of the eight participants demonstrated reliable pre- to post-treatment clinical improvements on depression and stress scales, and one participant demonstrated a reliable reduction on an anxiety scale. Two participants demonstrated a reliable improvement in overall anxiety. The results indicate that the UP applied to individuals diagnosed with primary BPD may lead to clinical improvement in depression, stress and anxiety for some individuals. However, the majority of individuals with BPD in our sample did not show strong improvement, and this suggests the need for additional sessions of UP or an intervention that focuses on the symptoms of BPD specifically for some women.

Key learning aims

  1. (1) To describe the applicability of the Unified Protocol in the treatment of individuals with borderline personality and co-occurring anxiety or depression.

  2. (2) To understand the value of utilizing a transdiagnostic approach as an alternative to diagnosis-specific approaches to treatment.

  3. (3) To identify the four core modules of the Unified Protocol and describe the general format for individual treatment.

Keywords

borderline personality disordercomorbid disordersemotional disorderspsychotherapytransdiagnostictreatment outcome
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e37
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019. 

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References

Further reading

Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.CrossRefGoogle Scholar
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cognitive and Behavioral Practice, 17, 88–101.CrossRefGoogle Scholar
Thompson-Hollands, J., Sauer-Zavala, S., & Barlow, D. H. (2014). CBT and the future of personalized treatment: a proposal. Depression and Anxiety, 31, 909–911.CrossRefGoogle ScholarPubMed

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (revised 4th edn). Washington, DC, USA: American Psychiatric Association.Google Scholar
Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.CrossRefGoogle Scholar
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Therapist Guide. New York, NY, USA: Oxford University Press.Google Scholar
Barlow, D. H., Nock, M. K., & Herson, M. (2009). Single Case Experimental Designs: Strategies for Studying Behavior Change (3rd edn). Boston, MA, USA: Pearson and Allyn & Bacon.Google Scholar
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014). The nature, diagnosis, and treatment of neuroticism: back to the future. Clinical Psychological Science, 2, 344–365.CrossRefGoogle Scholar
Basco, M., Bostic, J. Q., Davies, D., Rush, A., Witte, B., Hendrickse, W., & Barnett, V. (2000). Methods to improve diagnostic accuracy in a community mental health setting. The American Journal of Psychiatry, 157, 1599–1605.CrossRefGoogle Scholar
Bentley, K. H., Gallagher, M. W., Carl, J. R., & Barlow, D. H. (2014). Development and validation of the overall depression severity and impairment scale. Psychological Assessment, 26, 815–830. doi: 10.1037/a0036216 CrossRefGoogle ScholarPubMed
Bohus, M., Limberger, M. F., Frank, U., Sender, I., Gratwohl, T., & Stieglitz, R. (2001). Entwicklung der Borderline-Symptom-Liste. Psychotherapie Psychosomatik Medizinische Psychologie, 51, 201–211. doi: 10.1055/s-2001-13.281 CrossRefGoogle Scholar
Boswell, J. F., Anderson, L. M., & Barlow, D. H. (2014). An ideographic analysis of change processes in the unified transdiagnostic treatment of depression. Journal of Consulting and Clinical Psychology, 82, 1060–1071.CrossRefGoogle Scholar
Brown, T. A. (2007). Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorder constructs. Journal of Abnormal Psychology, 116, 313–328.CrossRefGoogle ScholarPubMed
Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79–89.CrossRefGoogle Scholar
Bullis, J. R., Fortune, M. R., Farchione, T. J., & Barlow, D. H. (2014). A preliminary investigation of the long-term outcome of the unified protocol for transdiagnostic treatment of emotional disorders. Comprehensive Psychiatry, 55, 1920–1927.CrossRefGoogle ScholarPubMed
Campbell-Sills, L., Norman, S. B., Craske, M. G., Sullivan, G., Lang, A. J., Chavira, D. A., … & Stein, M. B. (2009). Validation of a brief measure of anxiety-related severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS). Journal of Affective Disorders, 112, 92–101. doi: 10.1016/j.jad.2008.03.014 CrossRefGoogle Scholar
Crawford, J. R. & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111–131.CrossRefGoogle Scholar
Derogatis, L. R. (2001). Brief Symptom Inventory (BSI)-18: Administration, Scoring and Procedures Manual. Minneapolis, MN, USA: NCS Pearson.Google Scholar
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cognitive and Behavioral Practice, 17, 88–101.CrossRefGoogle Scholar
Ellard, K. K., Deckersbach, T., Sylvia, L. G., Nierenberg, A. A., & Barlow, D. H. (2012). Transdiagnostic treatment of bipolar disorder and comorbid anxiety with the unified protocol: a clinical replication series. Behavior Modification, 36, 482–508.CrossRefGoogle ScholarPubMed
Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186.CrossRefGoogle ScholarPubMed
Erickson, D. H., Janeck, A. S., & Tallman, K. (2007). A cognitive-behavioral group for patients with various anxiety disorders. Psychiatric Services, 58, 1205–1211.CrossRefGoogle Scholar
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., … & Barlow, D. H. (2012). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: a randomized controlled trial. Behavior Therapy, 43, 666–678.CrossRefGoogle ScholarPubMed
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC, USA: American Psychiatric Press.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured Clinical Interview for DSM-Axis II Disorders (SCID-II). Washington, DC, USA: American Psychiatric Press.Google Scholar
Frank, J. D. (1968). The role of hope in psychotherapy. International Journal of Psychiatry, 5, 383–395.Google ScholarPubMed
Grant, B. F., Chou, S., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., & … Ruan, W. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69, 533–545.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Kazdin, A. E. (2003). Research Design in Clinical Psychology. Boston, MA, USA: Allyn & Bacon.Google Scholar
Lobbestael, J. Leurgans, M. & Arntz, A. (2010). Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clinical Psychology and Psychopathology, 18, 75–79. doi: 10.1002/cpp.693 CrossRefGoogle Scholar
Lopez, M. E., Stoddard, J. A., Noorollah, A., Zerbi, G., Payne, L. A., Hitchcock, C. A., … & Ray, D. B. (2014). Examining the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders in the treatment of individuals with borderline personality disorder. Cognitive and Behavioral Practice, 22, 522–533.CrossRefGoogle Scholar
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd edn). Sydney, Australia: Psychology Foundation.Google Scholar
Maffei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Deborah, D., … & Petrachi, M. (1997). Interrater reliability and internal consistency of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), version 2.0. Journal of Personality Disorders, 11, 279–284.CrossRefGoogle ScholarPubMed
Mansell, W., Harvey, A., Watkins, E., & Shafran, R. (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy: An International Quarterly, 23, 6–19. doi: 10.1891.0889-8391.23.1.6 CrossRefGoogle Scholar
Norman, S. B., Cissell, S. H., Means-Christensen, A. J., & Stein, M. B. (2006). Development and validation of an overall severity and impairment scale (OASIS). Depression and Anxiety, 23, 245–249. doi: 10.1002/da.20182 CrossRefGoogle Scholar
Norton, P. J., Hayes, S. A., & Hope, D. A. (2004). Effects of a transdiagnostic group treatment for anxiety on secondary depression. Depression and Anxiety, 20, 198–202.CrossRefGoogle ScholarPubMed
Sauer-Zavala, S., Bentley, K. H., & Wilner, J. G. (2015). Transdiagnostic treatment of borderline personality disorder and comorbid disorders: a clinical replication series. Journal of Personality Disorders, 29, 179.Google Scholar
Skodol, A. E., Rosnick, L., Kellman, D., & Oldham, J. M. (1988). Validating structured DSM-III-R personality disorder assessments with longitudinal data. The American Journal of Psychiatry, 145, 1297–1299.Google ScholarPubMed
Thompson-Hollands, J., Sauer-Zavala, S., & Barlow, D. H. (2014). CBT and the future of personalized treatment: a proposal. Depression and Anxiety, 31, 909–911.CrossRefGoogle ScholarPubMed
Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998). Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry, 155, 1733–1739.CrossRefGoogle ScholarPubMed
Zanarini, M. C., Skodol, A. E., Bender, D., Dolan, R., Sanislow, C., Schaefer, E., … & Gunderson, J. G. (2000). The collaborative longitudinal personality disorders study: reliability of axis I and II diagnoses. Journal of Personality Disorders, 14, 291–299.CrossRefGoogle ScholarPubMed
Zimmerman, M., & Mattia, J. I. (1999). Axis I diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry, 40, 245–252.CrossRefGoogle ScholarPubMed
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