Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment for borderline personality disorder (BPD) that is based on the theory that emotion dysregulation is the core feature of BPD. This article focuses on aspects of DBT theory and techniques that specifically address emotion. The dialectical and biosocial theories that underlie DBT are reviewed with an emphasis on how each relates to emotional experiencing in BPD. Selected treatment strategies that address emotion dysregulation and their hypothesized mechanisms of change are also described. Relevant research findings are incorporated throughout to provide an empirical foundation for the DBT theories and strategies that are discussed.     

Attachment in Adolescence and Borderline Personality Disorder

Borderline personality disorder (BPD) has been conceptualized as a constellation of symptoms related to problems in self-functioning, emotion regulation, and interpersonal relationships. Its etiology has been connected to individuals’ early childhood environment, caregiving relationships, and traumatic life events. Recent literature has noted the potential presence of BPD beginning in adolescence, or even earlier in childhood. Attachment theory offers a lens for understanding the symptoms of borderline personality disorder and identifying potential aspects of treatment that may be specifically valuable for adolescent patients. Adolescence marks a time when the attachment system has increased relevance due to the importance of identity formation, peer relationships, body representations and the development of autonomy at this time, in the face of physical changes and academic challenges. This article will summarize research on attachment, body representations, personality disorders, and features of development in adolescence, in order to enhance clinical understanding of patients who presenting with these types of difficulties.     

Effectiveness of Psychodynamic Treatment in Patients with Borderline Personality Disorder

There is some evidence that the efficacy of four types of psychotherapeutic psychotherapy (mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy), is superior to treatment-as-usual. More controlled and randomized studies are needed in order a) to confirm the results of the relatively few investigations that were available, b) to examine the therapeutic relevance and usefulness of correlates and predictors of improvement and remission in borderline patients, and c) to examine possible fruitful combinations with other types of treatment.     

Dysfunctional beliefs and psychopathology in Borderline Personality Disorder

This study examined the factor structure of the Borderline Personality Disorder subscale of the Personality Beliefs Questionnaire (PBQ-BPD; Butler, Brown, Beck, & Grisham, 2002), and the relationships between the emergent factors and psychopathology. The sample comprised 184 patients diagnosed with borderline personality disorder (BPD). Exploratory factor analysis yielded three factors relating respectively to dependency, distrust, and the belief that one should act preemptively to avoid threat. Although the three factors were significantly associated with depression, only dependency and distrust significantly correlated with hopelessness. Distrust was the sole factor that correlated significantly with suicide ideation. These findings support the dimensional structure of the PBQ-BPD. Given its multidimensional structure, the scale can be used as a measure of belief profiles associated with BPD and as an aid to conceptualizing beliefs underlying a range of psychopathology associated with patients with BPD.     

Recognition of facial affect in Borderline Personality Disorder

Patients with Borderline Personality Disorder (BPD) have been described as emotionally hyperresponsive, especially to anger and fear in social contexts. The aim was to investigate whether BPD patients are more sensitive but less accurate in terms of basic emotion recognition, and show a bias towards perceiving anger and fear when evaluating ambiguous facial expressions. Twenty-five women with BPD were compared with healthy controls on two different facial emotion recognition tasks. The first task allowed the assessment of the subjective detection threshold as well as the number of evaluation errors on six basic emotions. The second task assessed a response bias to blends of basic emotions. BPD patients showed no general deficit on the affect recognition task, but did show enhanced learning over the course of the experiment. For ambiguous emotional stimuli, we found a bias towards the perception of anger in the BPD patients but not towards fear. BPD patients are accurate in perceiving facial emotions, and are probably more sensitive to familiar facial expressions. They show a bias towards perceiving anger, when socio-affective cues are ambiguous. Interpersonal training should focus on the differentiation of ambiguous emotion in order to reduce a biased appraisal of others.     

Impulsivity and emotion dysregulation in Borderline Personality Disorder

This study examined the association of borderline personality disorder (BPD) and negative emotional states with impulsivity in the laboratory. Undergraduate participants who were high in BPD features (high-BPD; n = 39) and controls who were low in BPD features (low-BPD; n = 56) completed measures of negative emotional state before a laboratory measure of impulsivity--a passive avoidance learning task. Controlling for psychopathology, high-BPD participants committed a greater number of impulsive responses than did low-BPD participants. Negative emotional state moderated the effect of BPD on impulsive responses. High-BPD participants who were in a negative emotional state committed fewer impulsive responses than high-BPD participants who were low in negative emotional state. Fear, nervousness, and shame negatively correlated with impulsivity among high-BPD participants but not among low-BPD participants. In addition, high-BPD participants reported greater emotion dysregulation in a variety of domains, compared with low-BPD participants.     

Feasibility of Using Video to Teach a Dialectical Behavior Therapy Skill to Clients With Borderline Personality Disorder

This study tested the feasibility of using a psychoeducational video recording to teach a behavioral skill from the Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b) skills training program to individuals meeting criteria for borderline personality disorder. A video presenting a DBT emotion-regulation skill was developed and the extent to which viewers learned the skill material was evaluated via a randomized controlled trial (RCT), utilizing a within-subjects design. Thirty individuals meeting DSM-IV criteria for borderline personality disorder participated. Participants were recruited from mental health treatment settings and were naïve to DBT. Viewing the video was associated with significant increases in knowledge of the skill, relative to viewing a control video, and with increases in participants' expectations of positive outcomes for skill use. In addition, participants rated the video as relevant and helpful. A remarkably high number (80%) utilized the skill taught subsequent to viewing the video when assigned to do so, and overall reported significant decreases in negative affect after using the skill. Video appears to be feasible as a medium for teaching DBT skills material under controlled conditions; future research is needed to examine the effectiveness of video in more naturalistic settings.     

高边缘性人格障碍特质者负性沉浸的自我反思倾向

采用自我参照范式考察边缘性人格障碍(BPD)的自我反思特点。实验1对比高、低BPD特质被试在自我和姓名参照条件下正负性词汇的再认成绩,发现高BPD特质者在自我参照条件下的负性词汇记忆成绩显著高于低BPD特质组。实验2对高BPD特质被试进行正念自我反思训练,结果发现相对于对照组,训练组在自我参照条件下负性词汇的记忆成绩显著降低。高BPD特质者的自我反思存在负性沉浸倾向,且正念自我反思训练可以改善该倾向。     

Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients’ practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according to the skills deficit model of BPD that underlies DBT. This study was designed to examine the type and frequency of skills practiced by DBT patients. Participants were 49 women, who met criteria for BPD and current and chronic suicidal behavior, receiving 1 year of standard DBT as part of a clinical trial. Skills were recorded on the daily diary cards completed by participants each week and reviewed by their individual therapists. Results indicated that the majority of participants reported practicing skills most days throughout treatment. Crisis survival and mindfulness skills were practiced most frequently in our sample. Hierarchical linear modeling demonstrated that skills practice increased as a function of time in therapy. Directions for future research are discussed.     

Systemic work with clients with a diagnosis of Borderline Personality Disorder

Clients who are diagnosed with Borderline Personality Disorder are likely to engage with clinicians in compelling ways. They challenge us with an urgency that helps us to define ourselves as we work with them. They confront us with the limitations of our treatment approaches, requiring a genuineness of interaction and a flexibility that can be both challenging and uncomfortable. While therapists have made great strides over the past few decades in their treatment approaches with this population, there is a gap in the literature on the use of systemic approaches with these clients. This article examines some of the issues that arise in work with people with a diagnosis of Borderline Personality Disorder and offers an application of a larger systems perspective to the development of viable treatment options for these clients.     

Experiential Avoidance and Emotion Regulation in Borderline Personality Disorder

Many of the severe behavioral difficulties observed among persons with BPD (e.g., self-harm, suicidal behaviors) have been conceptualized as attempts to avoid or escape unwanted emotional experiences. As such, experiential avoidance likely plays a prominent role in the difficulties faced by persons with BPD. Individuals with BPD have demonstrated heightened levels of experiential avoidance in several studies. Several key features of BPD may contribute to experiential avoidance among persons with BPD, including a vulnerability to negative or distressing emotions, difficulty regulating emotions, and distress intolerance. Some research also suggests that a vulnerability to negative emotions among persons with BPD may be partly due to the use of experiential avoidance strategies to cope with emotional experiences. Within this paper, we review the literature on experiential avoidance and possible mechanisms underlying experiential avoidance among persons with BPD, and discuss the research and clinical implications of this literature.     

Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder

Individuals diagnosed with borderline personality disorder (BPD) are notoriously difficult to engage in treatment. The purpose of this paper is to highlight therapeutic strategies that are likely to facilitate early alliance in therapy with individuals diagnosed with BPD. The seven strategies include, collaborative assessment, the use of contracts, motivational interviewing, linking treatment targets to client goals, commitment strategies, validation, and the use of metaphors. Clinical vignettes are presented to elucidate the concepts described and demonstrate their use in clinical practice.     

Emotional responses to a negative emotion induction procedure in Borderline Personality Disorder

The aim of this study was to determine if patients with Borderline Personality Disorder (BPD) present higher emotional response than healthy controls in a laboratory setting. Fifty participants (35 patients with BPD and 15 healthy controls) underwent a negative emotion induction procedure (presentation of standardized unpleasant images). Subjective emotional responses were assessed by means of self-reported questionnaires while biological reactivity during the procedure was measured through levels of salivary cortisol (sCORT) and alphaamylase (sAA). Patients with BPD exhibited significant lower cortisol levels and higher sAA levels compared to controls. Self-reported emotional reactivity did not give rise to differences between groups but participants with BPD did present higher levels of negative emotional intensity at baseline and during the entire procedure. The findings do not give support to the emotional hyperreactivity hypothesis in BPD. However, BPD patients presented heightened negative mood intensity at baseline, which should be considered a hallmark of the disorder. Further studies using more BPD-specific emotion inductions are needed to confirm the trends observed in this study.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.