Searching in the dark: Shining a light on some predictors of non-response to psychotherapy for borderline personality disorder.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
22
12
2020
accepted:
08
07
2021
entrez:
27
7
2021
pubmed:
28
7
2021
medline:
10
11
2021
Statut:
epublish
Résumé
Borderline Personality Disorder (BPD) is a prevalent and serious mental health condition. People can experience recovery or remission after receiving psychotherapy for BPD; however, it is estimated that about 45% of people in well conducted treatment trials do not respond adequately to current psychological treatments. To further advance psychotherapies for BPD by identifying the factors that contribute to the problem of non-response. 184 consecutive participants with BPD in community treatment were naturalistically followed up over 12 months and measures of personality and social functioning were examined. Logistic regressions were used to determine which baseline factors were associated with the likelihood of being a non-responder after 12 months of psychotherapy. After 12 months, 48.4% of participants were classed as non-responders due to a lack of reduction in BPD symptoms according to the Reliable Change Index (RCI) method. At baseline intake, patients who endorsed an adult preoccupied attachment relationship style and increased anger were more likely to be a non-responder regarding BPD symptoms at 12 months. In addition, those with preoccupied attachment patterns in their adult relationships were more likely to be non-responders regarding general psychological distress at follow up. Higher baseline levels of paranoia and endorsement of a dismissive adult relationship style was associated with being a non-responder in regard to global functioning. Consistent with previous research, almost half of the sample did not achieve reliable change at 12-month follow up. A relationship style characterised by preoccupied insecurity and high anger seemed to be particularly challenging in being able to benefit from psychotherapy. This style may have affected both relationships outside, but also inside therapy, complicating treatment engagement and alliance with the therapist. Early identification and modification of treatment based on challenges from these relationship styles may be one way to improve psychotherapy outcomes for BPD.
Sections du résumé
BACKGROUND
Borderline Personality Disorder (BPD) is a prevalent and serious mental health condition. People can experience recovery or remission after receiving psychotherapy for BPD; however, it is estimated that about 45% of people in well conducted treatment trials do not respond adequately to current psychological treatments.
AIM
To further advance psychotherapies for BPD by identifying the factors that contribute to the problem of non-response.
METHOD
184 consecutive participants with BPD in community treatment were naturalistically followed up over 12 months and measures of personality and social functioning were examined. Logistic regressions were used to determine which baseline factors were associated with the likelihood of being a non-responder after 12 months of psychotherapy. After 12 months, 48.4% of participants were classed as non-responders due to a lack of reduction in BPD symptoms according to the Reliable Change Index (RCI) method.
RESULTS
At baseline intake, patients who endorsed an adult preoccupied attachment relationship style and increased anger were more likely to be a non-responder regarding BPD symptoms at 12 months. In addition, those with preoccupied attachment patterns in their adult relationships were more likely to be non-responders regarding general psychological distress at follow up. Higher baseline levels of paranoia and endorsement of a dismissive adult relationship style was associated with being a non-responder in regard to global functioning.
CONCLUSIONS
Consistent with previous research, almost half of the sample did not achieve reliable change at 12-month follow up. A relationship style characterised by preoccupied insecurity and high anger seemed to be particularly challenging in being able to benefit from psychotherapy. This style may have affected both relationships outside, but also inside therapy, complicating treatment engagement and alliance with the therapist. Early identification and modification of treatment based on challenges from these relationship styles may be one way to improve psychotherapy outcomes for BPD.
Identifiants
pubmed: 34314461
doi: 10.1371/journal.pone.0255055
pii: PONE-D-20-40294
pmc: PMC8315515
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0255055Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Pers Disord. 2011 Aug;25(4):432-47
pubmed: 21838560
World Psychiatry. 2014 Oct;13(3):314-6
pubmed: 25273306
J Clin Psychol. 2008 Jun;64(6):667-86
pubmed: 18384120
J Pers Disord. 2017 Dec;31(6):774-789
pubmed: 28263092
J Clin Psychol. 2018 Nov;74(11):1996-2013
pubmed: 30238450
Clin Psychol Psychother. 2013 May-Jun;20(3):216-25
pubmed: 22109975
PLoS One. 2018 Nov 6;13(11):e0206472
pubmed: 30399184
World Psychiatry. 2010 Feb;9(1):11-5
pubmed: 20148147
Psychol Methods. 2002 Jun;7(2):147-77
pubmed: 12090408
J Pers Disord. 2015 Oct;29(5):575-609
pubmed: 26393477
Attach Hum Dev. 2014;16(2):192-209
pubmed: 24329043
Behav Res Ther. 2009 Nov;47(11):961-73
pubmed: 19698939
J Consult Clin Psychol. 1991 Feb;59(1):12-9
pubmed: 2002127
Psychiatry Res. 2001 Dec 31;105(3):243-53
pubmed: 11814543
Am Psychol. 1995 Dec;50(12):1003-20
pubmed: 8561378
J Consult Clin Psychol. 1996 Feb;64(1):22-31
pubmed: 8907081
Personal Ment Health. 2019 Nov;13(4):230-238
pubmed: 31411004
Psychol Psychother. 2002 Dec;75(Pt 4):445-59
pubmed: 12626134
Int J Psychoanal. 1995 Feb;76 ( Pt 1):39-44
pubmed: 7775035
Psychiatr Serv. 2003 Aug;54(8):1149-54
pubmed: 12883144
Personal Ment Health. 2018 Nov;12(4):334-344
pubmed: 30136443
Br J Med Psychol. 2000 Jun;73 ( Pt 2):197-210
pubmed: 10874479
J Pain. 2008 Mar;9(3):210-6
pubmed: 18055267
BMC Psychiatry. 2014 Oct 03;14:239
pubmed: 25277100
J Affect Disord. 2019 Mar 1;246:530-547
pubmed: 30599378
J Trauma Stress. 2010 Aug;23(4):421-9
pubmed: 20648564
Psychiatr Q. 2007 Jun;78(2):129-43
pubmed: 17347875
Br J Psychiatry. 2010 May;196(5):389-95
pubmed: 20435966
Borderline Personal Disord Emot Dysregul. 2020 Aug 10;7:16
pubmed: 32789019
Early Interv Psychiatry. 2011 Aug;5(3):249-53
pubmed: 21521492
Behav Res Ther. 2013 Aug;51(8):411-6
pubmed: 23727659
Psychother Res. 2000 Dec;10(4):421-34
pubmed: 21756114
J Clin Psychol. 2017 Dec;73(12):1599-1611
pubmed: 28221671
Acta Psychiatr Scand. 2013 Apr;127(4):305-17
pubmed: 22897123
Am J Psychiatry. 1995 May;152(5):789-91
pubmed: 7726321
J Int Neuropsychol Soc. 2004 Oct;10(6):888-93
pubmed: 15637779
Clin Psychol Rev. 2001 Apr;21(3):421-46
pubmed: 11288608
Psychiatr Serv. 2010 Jun;61(6):612-6
pubmed: 20513685
J Consult Clin Psychol. 2005 Oct;73(5):982-9
pubmed: 16287398
Bull Menninger Clin. 2003 Summer;67(3):227-59
pubmed: 14621064
Australas Psychiatry. 2012 Oct;20(5):419-24
pubmed: 23014120
Personal Disord. 2010 Jul;1(3):170-9
pubmed: 22448633
Compr Psychiatry. 2009 Jul-Aug;50(4):335-46
pubmed: 19486732
Australas Psychiatry. 2019 Feb;27(1):56-59
pubmed: 30226078
Acta Psychiatr Scand. 2010 Aug;122(2):103-9
pubmed: 20199493
Health Qual Life Outcomes. 2005 Aug 08;3:48
pubmed: 16083512
J Pers Disord. 2009 Aug;23(4):346-56
pubmed: 19663655
Int J Psychoanal. 2007 Aug;88(Pt 4):917-37
pubmed: 17681900
Psychiatry Res. 2018 Apr;262:40-45
pubmed: 29407567
Br J Psychiatry. 2020 Feb;216(2):69-78
pubmed: 31298170
Acta Psychiatr Scand. 2009 Jul;120(1):53-61
pubmed: 19183126
Clin Psychol Psychother. 2016 Jul;23(4):308-18
pubmed: 25847057
J Pers Disord. 2014 Dec;28(6):796-809
pubmed: 24689763
Clin Psychol Rev. 2020 Feb;75:101808
pubmed: 31864153
JAMA Psychiatry. 2017 Apr 01;74(4):319-328
pubmed: 28249086
J Psychiatr Pract. 2009 May;15(3):173-82
pubmed: 19461390
Psychiatry Res. 2009 Aug 15;168(3):250-5
pubmed: 19185354
Personal Disord. 2019 Nov;10(6):491-499
pubmed: 31414854
J Pers Disord. 2003 Dec;17(6):568-73
pubmed: 14744082
Personal Disord. 2014 Jan;5(1):97-107
pubmed: 24588066
Psychopathology. 2005 Mar-Apr;38(2):64-74
pubmed: 15802944
Am J Psychiatry. 2013 Jun;170(6):671-9
pubmed: 23558452
Arch Gen Psychiatry. 2006 Jun;63(6):649-58
pubmed: 16754838
Med J Aust. 2013 May 20;198(9):464-5
pubmed: 23682874
Clin Psychol Psychother. 2021 May;28(3):633-641
pubmed: 33119970
J Clin Psychol. 2008 Mar;64(3):231-44
pubmed: 18302208
BMC Psychiatry. 2019 Nov 6;19(1):341
pubmed: 31694681
J Pers Assess. 2004 Feb;82(1):50-9
pubmed: 14979834
Psychother Psychosom Med Psychol. 2007 Mar-Apr;57(3-4):154-60
pubmed: 17523235
Harv Rev Psychiatry. 2016 Sep-Oct;24(5):342-56
pubmed: 27603742
BMC Psychiatry. 2017 Jun 9;17(1):215
pubmed: 28599621
Am J Psychiatry. 1995 Sep;152(9):1386-8
pubmed: 7653701
Dev Psychopathol. 2005 Fall;17(4):959-86
pubmed: 16613426
Psychiatr Serv. 2019 Sep 1;70(9):772-781
pubmed: 31138059
J Behav Ther Exp Psychiatry. 2014 Jun;45(2):242-51
pubmed: 24342235
Med Care. 1991 Feb;29(2):169-76
pubmed: 1994148
J Behav Ther Exp Psychiatry. 2009 Jun;40(2):317-28
pubmed: 19176222
J Pers Soc Psychol. 1991 Aug;61(2):226-44
pubmed: 1920064
Arch Gen Psychiatry. 2011 Aug;68(8):827-37
pubmed: 21464343
Am J Psychiatry. 2012 May;169(5):476-83
pubmed: 22737693
Behav Res Ther. 2016 Feb;77:162-9
pubmed: 26764586
Br J Clin Psychol. 2002 Nov;41(Pt 4):417-22
pubmed: 12437796
Cochrane Database Syst Rev. 2020 May 4;5:CD012955
pubmed: 32368793
Harv Rev Psychiatry. 2004 Mar-Apr;12(2):94-104
pubmed: 15204804
J Am Psychoanal Assoc. 2000;48(4):1129-46; discussion 1175-87
pubmed: 11212185
Psychotherapy (Chic). 2013 Mar;50(1):42-51
pubmed: 23505980
Clin Psychol Rev. 2016 Jun;46:124-35
pubmed: 27188635
Clin Psychol Rev. 2012 Jul;32(5):400-12
pubmed: 22681913
J Consult Clin Psychol. 1995 Dec;63(6):1044-8
pubmed: 8543708
J Abnorm Psychol. 1976 Aug;85(4):383-9
pubmed: 956505
J Pers Disord. 2008 Feb;22(1):22-41
pubmed: 18312121
J Psychiatr Res. 2020 Oct;129:241-249
pubmed: 32823217