The Role of Coping Change in Borderline Personality Disorder: A Process-Outcome Analysis on Dialectical-Behaviour Skills Training.

Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Skills training concepts based on dialectical-behaviour therapy (DBT) are common and effective treatment options for specifically addressing lacking skills in emotion regulation. However, so far it is unclear which aspects of coping change over the course of DBT skills training and if these coping strategies predict symptom change. The present process-outcome analysis, based on a randomized controlled study, aims at investigating these questions, by referring to a general conception of coping and by using an observer-rated approach to assess coping strategies directly in the therapy sessions. In total, n = 31 patients with BPD underwent two individual clinical interview assessments (pre- and post-study intervention; half of the patients underwent DBT skills training, half were in a wait-list control). All individual assessment sessions were transcribed and analysed using the Coping Action Pattern Rating Scale. Outcome was assessed pre- and post-intervention using the Outcome Questionnaire-45.2 and the Borderline Symptom List 23. The results showed increase in overall coping functioning in patients who underwent the DBT skills training, compared with the controls, and specific increases in relatedness coping where the stress is appraised as challenge, along with specific decreases in autonomy coping where the stress is appraised as threat. These changes predicted changes in general distress and borderline symptomatology. The results are interpreted within a general framework aiming at understanding the psychological effects of treatments for BPD, in particular effects related to coping. Effective emotion regulation strategies may therefore be important candidates as potential change mechanisms in treatments for BPD. Copyright © 2016 John Wiley & Sons, Ltd. It seems important for clinicians to assess the quality of coping strategies as they occur within the session facing a patient with borderline personality disorder. Clinicians may foster the emergence of support-seeking and self-reliance coping strategies in order to increase the effectiveness of therapy. Clinicians may monitor closely the patient's use of ineffective emotion regulation strategies, in particular opposition and submission, with the aim of reducing them early in therapy

Process and impact of dialectical behaviour therapy: a systematic review of perceptions of clients with a diagnosis of borderline personality disorder

Purpose: To identify, appraise and synthesise findings from qualitative studies of individuals diagnosed with Borderline Personality Disorder who have experienced Dialectical Behaviour Therapy, to gain further understanding of their perceptions of the process and impact of therapy. Methods: We conducted a comprehensive systematic search of the literature from several online databases, and appraised them using an adapted version of the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesise the data. Results: Seven studies met the criteria to be included and their quality subsequently appraised. Four main themes were identified through the synthesis process: Life before DBT; the relationships that support change; developing self-efficacy; a shift in perspectives. Conclusions: The findings of the synthesis highlight the importance of a number of key factors in the process of DBT, and the impact that the therapy has both on day to day life and on individuals’ identity

Emotional Dysregulation as a target in the treatment of co-existing substance use and borderline personality disorders: A pilot study

Background: Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD) are frequently co-morbid and their co-occurrence exacerbates the symptomatology and associated harms for both disorders. However, few intervention studies have examined the delivery of an integrated intervention for BPD and SUD within alcohol and other drug (AOD) treatment settings. This single arm pilot study examined the clinical utility and outcomes of a 12-session emotion regulation intervention for clients with co-occurring SUD and BPD symptoms delivered in an outpatient AOD treatment setting. Method: Forty-five adult treatment-seekers (64.4% women, mean age 35.8 years [SD=10.4]) attending an outpatient AOD service, who exhibited three or more symptoms of BPD, engaged in a 12-session emotion regulation intervention. Clinical measures assessing alcohol and drug use, BPD symptoms, emotion dysregulation and acceptance, non-avoidance of thoughts and emotions, and psychological flexibility were collected at baseline, session six and session 12. Treatment engagement, satisfaction and rapport were also measured. Results: Fifty-one percent of participants completed the 12-session intervention. The results demonstrated that the number of drug using occasions in the past 28 days significantly reduced from baseline compared to session 12. Furthermore, a significant reduction was identified in BPD symptom severity, emotion dysregulation, and non-acceptance, experiential avoidance and psychological inflexibility from baseline to session 12. Conclusions: For those individuals who completed the 12-session emotion regulation intervention, there were significant reductions across a number of clinical outcomes. However, retention in treatment for this vulnerable client group remains a significant challenge in the AOD setting

Mortality Rates for Bladder Cancer Patients Who Use Tobacco: Outcome of Surgery Alone vs Surgery, Chemotherapy, and Adjuvant Treatment

Purpose. Bladder cancer is responsible for over 12,000 deaths annually and the ninth most frequent cancer worldwide. Many bladder cancers can be managed conservatively, requiring a cystoscopic removal of identified cells. Other cancers, which are staged as a more invasive type, are treated more aggressively with surgery, chemotherapy, radiation and other adjuvant therapies. Methods. Utilizing Florida Cancer Data from the Department of Health, we will determine if there are differences in mortality rates by measuring treatment outcomes of performing surgery alone (Sr) Vs Surgery, Chemotherapy, and Adjuvant (Sr + CT + Adj). We evaluated subsets of data including treatment options SR and SR+CT+Adj, also histology, staging and smoker, non smoker. Results. We reported RRmh = 1.18, (1.04, 1.35) of the adjusted association as a final effect of stage and smoking on the association of treatment and mortality. [1.18 – (2.13 – 1.17)] / 1.18 = 0.18 × 100 = 18%. Thus adjusting for Histology, patient with localized tumor who are smokers, are 18% more likely to die if they undergo Surgery + Chemotherapy + Adjuvant than if they undergo Surgery alone. Conclusion. Patients who underwent Chemotherapy with the surgery are 1.78 times more likely to die than those who underwent surgery alone. Assessment for bladder cancer must be done on clients presenting with symptoms and early management should be encouraged. Healthcare providers must perform in depth interviews to ascertain client smoking history and document on medical record