Euler Sebastian, Wrege Johannes, Busmann Mareike, Lindenmeyer Hannah J, Sollberger Daniel, Lang Undine E, Gaab Jens, Walter Marc
Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.
Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.
Front Psychol. 2018 May 28;9:824. doi: 10.3389/fpsyg.2018.00824. eCollection 2018.
Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients' social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively affected by the exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i.e., the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical questions. We further conclude that exclusion-proneness in BPD is a critical feature with respect to alliance in group treatments. In order to neutralize BPD patients' exclusion bias, therapists may be advised to provide an "inclusive stance," especially in initial sessions. It is also recommendable to strengthen patient to patient relations.
人际敏感性，尤其是潜在被排斥的威胁，是边缘型人格障碍（BPD）的一个关键状况，它会损害患者的社会适应能力。当前基于证据的治疗方法包括团体治疗成分，如基于心理化的团体治疗（MBT-G），以改善人际功能。这些治疗方法还注重治疗联盟，因为研究发现它是治疗效果的一个有力预测指标。然而，联盟是团体治疗的一个多维度因素，其中包括病友，因此可能会受到BPD患者易被排斥倾向的负面影响。这项初步研究的目的是检验社交排斥威胁对MBT-G中治疗联盟的预测价值。在研究的第一部分，使用网络抛球范式（一种虚拟抛球游戏）对23名BPD住院患者和28名健康受试者进行实验性诱导社交排斥。用需求-威胁量表（NTS）测量诱发的威胁水平，该量表涵盖人类基本需求的四个维度，即归属感需求、自尊需求、控制需求和有意义存在的需求。在研究的第二部分，使用团体问卷（GQ-D）从治疗师、病友和整个团体三个维度测量治疗联盟。根据NTS，BPD患者在被接纳和被排斥两种情况下的威胁水平都更高。被排斥后的威胁水平预测了MBT-G中治疗联盟的受损情况。它与更消极的关系、更低的积极联结以及与病友更低的积极工作联盟相关，并且与整个团体的积极联结更低，而未发现对治疗师的联盟有消极预测。因此，我们的转化研究设计表明网络抛球是一种适用于临床问题的方法。我们进一步得出结论，BPD患者的易被排斥倾向是团体治疗中关于联盟的一个关键特征。为了消除BPD患者的排斥偏见，建议治疗师采取“包容的姿态”，尤其是在初始阶段。加强患者之间的关系也是可取的。
