Borderline Personality Traits Predict Poorer Functioning during Partial Hospitalization: The Mediating Role of Depressive Symptomatology

A number of factors contribute to the difficulty providers experience in treating borderline personality disorder (BPD). One complicating factor for treatment effectiveness is the presence of comorbid affective psychopathology (e.g., depression, anxiety). Participants were 176 adults (60% female; Mage=32.20) in a partial hospital program. Using a mediation model, the current study examined the relationship among traits of BPD, affective symptomatology, and general functioning post-treatment. Additional analyses explored whether change in the perception of therapeutic skill implementation moderated the relationship among traits of BPD, affective symptomatology, and general functioning. Little improvement/worsening of depression during partial hospitalization, but not changes in anxiety, mediated the relationship between traits of BPD and poor general functioning. Additionally, regardless of changes in perception of cogntive- or dialectical-behavioral skill implementation, little improvement/worsening depressive symptomatology continued to mediate the negative relationship noted above. This study has important implications for treatment of BPD and suggests that targeting depressive symptoms in short-term settings may be crucial in acute stabilization

The Role of Positive Expectancies in Risk Behavior: An Exploration of Alcohol Use and Non- Suicidal Self-Injury

Background: Alcohol use and nonsuicidal self-injury (NSSI) appear to share a conceptual overlap in functions (e.g., tension reduction). Alcohol use has been identified as a risk factor for NSSI, and higher rates of alcohol use have been documented among those with NSSI history. Aims: This study examined whether NSSI-related alcohol expectancies affect relations between NSSI and alcohol use. Method: Participants were 367 college students (73% female) asked to complete an online survey about their drinking behavior and lifetime NSSI. Results: NSSI and alcohol use were highly prevalent in this sample: 56% endorsed lifetime NSSI and 74% endorsed current alcohol use. Of note, 43% (n = 147) endorsed both behaviors. Positive NSSI-related alcohol expectancies showed a significant association with lifetime NSSI. In addition, positive NSSI-related alcohol expectancies were associated with more frequent drinking behavior for individuals with a history of NSSI, particularly those who had engaged in two or more methods of lifetime NSSI. Conclusion: Alcohol use and NSSI represent high-risk behaviors commonly employed to regulate unwanted affective states. Interventions targeting substance use and/or NSSI may consider assessing positive NSSI and substance use expectancies, as the presence of these beliefs suggests a higher risk profile

Motivation for and use of social networking sites: Comparisons Among College Students With and Without Histories of Non-Suicidal Self-Injury

Objective: This research examines potential differences in social network use and motivation for social network use by non-suicidal self-injury (NSSI) status. Participants: 367 (73% women; Mage = 20.60) college students were recruited in November–December 2011. Methods: A random sample of 2,500 students was accessed through a university registrar to recruit students interested in an online survey assessing NSSI and various health-related behaviors. Results: Social network use and motivations for social networks did not differ by NSSI status. Conclusions: Results suggest that it is not patterns of use or motivation to use social networks that could lead to concern about online behavior (i.e., behavior increasing risk of future NSSI) among those with NSSI history. Rather, future preventive and intervention efforts should address the NSSI-related content that is available online, since this is unregulated, often explicit, and commonly includes “pro-NSSI” content that may be problematic and increase risk among vulnerable individuals

Sexual Orientation and Non-Suicidal Self-Injury: A Meta-Analytic Review

The aim of this study was to conduct the first meta-analysis comparing risk for NSSI between sexual minority and heterosexual persons. Eleven published and 4 unpublished studies were reviewed, describing associations between sexual orientation and NSSI in 7,147 sexual minority and 61,701 heterosexual participants. The overall weighted effect size for the relationship between sexual orientation and NSSI using a random-effects model was OR = 3.00 (95% CI = 2.46–3.66), indicating a medium-to-large effect. Sexual minority adolescents and bisexuals were found to be at particularly high-risk. These findings highlight the need to examine mechanisms linking sexual orientation and NSSI in future research. Building on these findings can add to understanding the associations between sexual orientation, NSSI, and suicidality, as well as prevention/intervention

The Impact of Social Contagion on Non-Suicidal Self-Injury: A Review of the Literature

In this review, we explore social contagion as an understudied risk factor for non-suicidal self-injury (NSSI) among adolescents and young adults, populations with a high prevalence of NSSI. We review empirical studies reporting data on prevalence and risk factors that, through social contagion, may influence the transmission of NSSI. Findings in this literature are consistent with social modeling/learning of NSSI increasing risk of initial engagement in NSSI among individuals with certain individual and/or psychiatric characteristics. Preliminary research suggests iatrogenic effects of social contagion of NSSI through primary prevention are not likely. Thus, social contagion factors may warrant considerable empirical attention. Intervention efforts may be enhanced, and social contagion reduced, by implementation of psychoeducation and awareness about NSSI in schools, colleges, and treatment programs

An Exploratory Mixed Methods Approach to Implicit and Explicit Identification with Non-Suicidal Self-Injury

Background and objectives: Identification with non-suicidal self-injury (NSSI) is uniquely related to NSSI behavior and predicts future NSSI. This exploratory, mixed methods study used implicit and explicit approaches to further understanding of NSSI identity. Methods: Participants included 15 treatment-seeking adults (60% female, 87% Caucasian) with lifetime NSSI. Participant age ranged from 19 to 38 years (M = 25.33, SD = 6.10). Implicit tasks were completed at two time points in a test-retest design, followed by a qualitative interview. Results: Qualitative data suggest that explicit NSSI identity is relevant to some individuals with NSSI history. Mixed methods analyses indicate that individuals who explicitly identify with NSSI have stronger implicit NSSI identities than those who do not, and report more methods of NSSI on average. Limitations: Results are novel, although exploratory in nature due to the sample size, and may not be generalizable to non-clinical samples or individuals currently engaging in NSSI. Conclusions: Individuals with stronger explicit identity evidence higher implicit identity scores, suggesting a potential higher risk profile for future NSSI. This study offers further support for the value of including both implicit and explicit assessment of NSSI identity in risk assessment

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

OBJECTIVE: This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder). METHOD: Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest. RESULTS: In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESɢ: UP = −1.72; SDP = −1.98), social anxiety (ESɢ: UP = −1.33, −0.86; SDP = −1.60, −1.54), and depression (ESɢ: UP = −0.83; SDP = −0.84). Significant differences were not observed in between-group comparisons. CONCLUSIONS: Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.Please note the following financial disclosures/conflicts of interest: Dr. Barlow reported receiving royalties from Oxford University Press, United Kingdom (which includes royalties for the treatment manuals included in this study); Guilford Publications Inc., United States; Cengage Learning, United States; Pearson Publishing, United Kingdom. He reported receiving grants from the National Institute of Mental Health, United States (R01 MH090053) and the National Institute of Alcohol and Alcohol Abuse, United States (R01 AA023676). He reported serving as a consultant for and receiving honoraria from the Agency for Healthcare Research and Quality, United States; the Foundation for Informed Medical Decision Making, United States; the Department of Defense, United States; the Renfrew Center, United States; the Chinese University of Hong Kong, Hong Kong;Universidad Catolica de Santa Maria, Peru); New Zealand Psychological Association, New Zealand; Hebrew University of Jerusalem, Israel; Mayo Clinic, United States; and various American universities. (R01 MH090053 - National Institute of Mental Health, United States; R01 AA023676 - National Institute of Alcohol and Alcohol Abuse, United States)Accepted manuscrip

From Urges to Action: Negative Urgency and Nonsuicidal Self-Injury in an Acute Transdiagnostic Sample

Urgency–rash action during strong emotion–is a robust correlate of nonsuicidal self-injury (NSSI). This study tested whether urgency is associated with time between NSSI urges and NSSI, and sought to replicate the finding that urgency is associated with NSSI history. Participants attending a partial hospitalization program (N = 669) completed self-report measures of urgency, NSSI history and latency, and psychiatric symptoms. Consistent with previous research in clinical samples, rates of lifetime engagement in NSSI were high. Using logistic regression to predict short vs. long latency between urges and NSSI, no significant relationship emerged between negative urgency and latency to self-injure. Negative urgency more than doubled the likelihood of NSSI history (p \u3c .001, OR = 2.39). In addition, exploratory analyses revealed several links between NSSI latency and negative urgency. Results confirm that urgency is robustly related to NSSI, yet also suggest that more research is needed to understand how urgency relates to the parameters of NSSI within those who self-injure. Use of retrospective self-report measures may limit the ability to test links between urgency and latency of NSSI

Implicit Associations with Non-Suicidal Self-Injury: Examination in a Clinical Sample by Borderline Personality Symptomatology

Objectives We examine correlates and predictors for implicit associations with non-suicidal self-injury (NSSI) with the Self-Injury Implicit Association Test (SI-IAT) in a treatment-seeking sample. We also examine group differences in the SI-IAT among those with low/none, moderate and high/clinically significant borderline personality disorder (BPD) symptomatology in a treatment-seeking sample. Methods Participants (N = 111; 58% female; 89% White; Mage = 30.25) completed the SI-IAT and self-report measures at two time points. Results Higher BPD symptom scores were significantly, positively correlated with implicit identification with NSSI, and predicted NSSI identity when controlling for depression indices, history of NSSI and other covariates. With Time 1 SI-IAT scores entered as a covariate, BPD scores no longer significantly predicted Time 2 SI-IAT scores. Individuals with moderate and high/clinically significant symptom counts of BPD had higher/stronger implicit associations with NSSI identity than those with no/low BPD symptoms. Conclusions Individuals with symptoms of BPD may implicitly identify with NSSI more than other clinical groups; examination of implicit assessments in BPD in future research is needed to further explore implicit identification with NSSI in this patient group to further understand both cross-sectional and prospective relations

Treating depressive disorders with the unified protocol: A preliminary randomized evaluation.

OBJECTIVES: This study aims to examine the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for individuals diagnosed with a depressive disorder. METHOD: Participants included 44 adults who met criteria for major depressive disorder, persistent depressive disorder, or another specified depressive disorder according to the Anxiety Disorder Interview Schedule (ADIS). These individuals represent a subset of patients from a larger clinical trial comparing the UP to single-disorder protocols (SDPs) for discrete anxiety disorders and a waitlist control (WLC) condition (Barlow et al., 2017); inclusion criteria for the parent study required participants to have a principal anxiety disorder. RESULTS: Significant reductions in depressive symptoms were observed within the UP condition across clinician-rated and self-report measures of depression from baseline to post-treatment, as well as to the 12-month follow-up assessment. Compared to the WLC group, individuals in the UP condition demonstrated significantly lower levels on our continuous, clinician-rated measure of depressive symptoms at post-treatment. There were no differences between the UP and SDP conditions on depressive symptoms at post-treatment or at the 12-month follow-up timepoint. CONCLUSIONS: In this exploratory set of analyses, the UP evidenced efficacy for reduction of depressive symptoms, adding to the growing support for its utility in treating depression.R01 MH090053 - NIMH NIH HHSAccepted manuscrip