Metacognitive improvement and symptom change in a 3-month treatment for borderline personality disorder.

Recognizing and reflecting on one's own and other people's mental states represent a major difficulty for patients with borderline personality disorder (BPD). Only recently have studies begun exploring whether these capacities increase with successful therapies and if such an improvement is linked with outcome. The present study investigated whether metacognition would improve and if its improvement was related with symptom change in BPD patients. The transcripts from the first and the penultimate session of a ten-session version of good psychiatric management were analysed with the MAS-R scale in a N = 37 BPD sample. Patients, selected from a previously published RCT (Kramer et al., 2014), were assigned either to the good psychiatric management treatment or to the same treatment with the addition of the Motive-Oriented Therapeutic Relationship (Caspar, 2007), a form of therapeutic relationship based on an individualized case formulation. Symptoms were assessed with the OQ-45. Findings partially support the hypotheses. First, improvement in capacities to understand others' mind, to take a critical distance from one's own rigid and maladaptive beliefs, and to use behavioural and attentional strategies to face adversities is found in both treatment groups. Controlling for marital status, only the ability to differentiate between reality and representations remains significant. Second, no link between metacognitive change and symptom change during treatment is found. However, a link is observed between the increase in metacognition and symptom reduction at 6-month follow-up. Results invite to further investigate the role of metacognition in therapy change through different modalities and in longer-term treatments. The development of metacognitive processes and their links with symptom change were examined during a short-term treatment in 37 borderline patients Improvement was found in capacities to understand others' mind, to take a critical distance from own rigid and maladaptive beliefs, and to use behavioural and attentional strategies even in a short-term treatment Controlling for marital status, only the ability to take a critical distance from representations remained significant A link was observed between increase in metacognition and symptom reduction at 6-month follow-up Understanding and tailoring interventions to specific metacognitive difficulties could be associated with symptom change during treatment for BPD patients

Raising children with high self-esteem (but not narcissism)

With the rise of individualism since the 1960s, Western parents have become increasingly concerned with raising children’s self-esteem. This is understandable, given the benefits of self-esteem for children’s psychological health. However, parents’ well-intentioned attempts to raise self-esteem, such as inflated praise, may inadvertently breed narcissism. How, then, can parents raise self-esteem without breeding narcissism? Here, we propose a tripartite model of self-regard, which holds that the development of self-esteem without narcissism can be cultivated through realistic feedback (rather than inflated praise), focus on growth (rather than on outperforming others), and unconditional regard (rather than regard that is conditional). We review evidence in support of these practices and outline promising research directions. The tripartite model integrates existing research, stimulates theory development, and identifies leverage points for intervention concurrently to raise self-esteem and curtail narcissism from a young age

Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study

Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction. This research was supported by SNSF and funded by Grant No: 100014_134562/1

Regret: A Theoretical and Conceptual Analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73569/1/j.1468-5914.1987.tb00092.x.pd

Changes in Prefrontal-Limbic Function in Major Depression after 15 Months of Long-Term Psychotherapy

Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed (DSM-IV) unmedicated outpatients (N = 16) and control participants matched for sex, age, and education (N = 17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy

Narcissistic Features in Young Adolescents: Relations to Aggression and Internalizing Symptoms

Recent research and theory suggest narcissistic features contribute to aggression in adults. The present study examined the association of narcissistic features with aggression and internalizing symptoms in 233 students of 5th–8th grade at three inner-city schools. A factor analysis of the Narcissistic Personality Inventory in this sample revealed three factors: Adaptive Narcissism, Exploitativeness, and Exhibitionism. Regression analyses were used to predict the association of these three narcissistic features with self-, teacher-, and peer-reported aggression and self-reported internalizing symptoms. Results indicate narcissistic exploitativeness positively predicted self-reported proactive aggression, and narcissistic exhibitionism positively predicted internalizing symptoms. Narcissism and self-esteem interacted to predict teacher-reported aggression and self-reported internalizing symptoms. Results are discussed in the context of existing theories of narcissism, threatened egotism, and self-perception bias.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45298/1/10964_2004_Article_485227.pd