Kramer Ueli
Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.
General Psychiatry Service, Department of Psychiatry-CHUV, University of Lausanne, Lausanne, Switzerland.
Clin Psychol Psychother. 2017 Mar;24(2):302-311. doi: 10.1002/cpp.2017. Epub 2016 Apr 21.
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.
情绪调节困难是边缘型人格障碍（BPD）患者的一个标志性特征。基于辩证行为疗法（DBT）的技能训练概念是专门解决情绪调节技能缺失问题的常见且有效的治疗选择。然而，到目前为止，尚不清楚在DBT技能训练过程中应对方式的哪些方面会发生变化，以及这些应对策略是否能预测症状变化。本过程-结果分析基于一项随机对照研究，旨在通过参考应对的一般概念并使用观察者评分法在治疗过程中直接评估应对策略来调查这些问题。总共有n = 31名BPD患者接受了两次个体临床访谈评估（研究干预前和干预后；一半患者接受DBT技能训练，另一半在等待名单对照组）。所有个体评估 sessions 都进行了转录，并使用应对行动模式评定量表进行分析。干预前和干预后使用结果问卷-45.2和边缘症状清单23评估结果。结果显示，与对照组相比，接受DBT技能训练的患者总体应对功能有所提高，在将压力评估为挑战的相关性应对方面有特定增加，而在将压力评估为威胁的自主性应对方面有特定减少。这些变化预测了一般痛苦和边缘症状的变化。结果在一个旨在理解BPD治疗心理效果，特别是与应对相关效果的总体框架内进行解释。因此，有效的情绪调节策略可能是BPD治疗中潜在变化机制的重要候选因素。版权所有© 2016约翰威立父子有限公司。
对于临床医生来说，在面对边缘型人格障碍患者的治疗过程中评估应对策略的质量似乎很重要。临床医生可以促进寻求支持和自我依赖应对策略的出现，以提高治疗效果。临床医生可以密切监测患者无效情绪调节策略的使用，特别是对立和顺从，以便在治疗早期减少它们。
