Department of Psychiatry and Psychotherapy, University Hospital Greifswald, Greifswald, Germany.
Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany.
Clin Psychol Psychother. 2019 May;26(3):339-349. doi: 10.1002/cpp.2355. Epub 2019 Feb 22.
Attachment characteristics play a key role in understanding borderline-specific problems with respect to childhood maltreatment. The aim of this study was to investigate how attachment representations may influence the trajectory of change in a 1-year outpatient dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD). Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP) before treatment. Borderline and global symptom severity and interpersonal problems were examined before, during, and after completing the intervention. Analysis of variance and stepwise hierarchical regression analyses were used to explore the course of symptomatology. As expected, BPD patients displayed a predominance of unresolved attachment in the AAP compared with HC, by showing a lack of ability to integrate attachment related trauma. Whereas both resolved and unresolved attachment groups revealed significant improvement in symptom severity during treatment, dimensional AAP scores showed differences. Patients with higher scores in "synchrony" demonstrated more indicators of mutual care in their narratives to dyadic pictures and displayed a significantly stronger decrease of interpersonal problems than patients with lower synchrony scores. Assessing attachment representations prior to DBT might provide a helpful insight into individual attachment related resources or lack of these capacities. Responsiveness and synchrony in dyadic interactions with significant others are crucial for healthy interpersonal relations. A stronger therapeutic focus on the patient's capacity to show synchrony in dyadic attachment situations might improve the patient's interpersonal problems towards sensitive and mutual interaction.
Attachment characteristics play a key role in understanding borderline-specific problems with respect to childhood maltreatment. 依恋特征在理解与儿童期虐待有关的边缘型特定问题方面起着关键作用。
The aim of this study was to investigate how attachment representations may influence the trajectory of change in a 1-year outpatient dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD). 本研究旨在探讨依恋表象如何影响边缘型人格障碍（BPD）患者为期 1 年的门诊辩证行为治疗（DBT）的变化轨迹。
Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP) before treatment. 在治疗前，使用成人依恋投射图片系统（AAP）评估了 26 名 BPD 患者和 26 名健康对照者（HC）的依恋表象。
Borderline and global symptom severity and interpersonal problems were examined before, during, and after completing the intervention. 在完成干预之前、期间和之后，检查了边缘型和总体症状严重程度以及人际问题。
Analysis of variance and stepwise hierarchical regression analyses were used to explore the course of symptomatology. 方差分析和逐步分层回归分析用于探索症状学的过程。
As expected, BPD patients displayed a predominance of unresolved attachment in the AAP compared with HC, by showing a lack of ability to integrate attachment related trauma. 正如预期的那样，与 HC 相比，BPD 患者在 AAP 中表现出未解决依恋的优势，表现出无法整合与依恋相关的创伤的能力。
Whereas both resolved and unresolved attachment groups revealed significant improvement in symptom severity during treatment, dimensional AAP scores showed differences. 尽管在治疗过程中，解决和未解决的依恋组都显示出症状严重程度的显著改善，但 AAP 维度分数显示出差异。
Patients with higher scores in "synchrony" demonstrated more indicators of mutual care in their narratives to dyadic pictures and displayed a significantly stronger decrease of interpersonal problems than patients with lower synchrony scores. “同步”得分较高的患者在对双人图片的叙述中表现出更多的相互关怀迹象，并且人际问题的减少明显强于同步得分较低的患者。
Assessing attachment representations prior to DBT might provide a helpful insight into individual attachment related resources or lack of these capacities. 在 DBT 之前评估依恋表象可能有助于深入了解个体依恋相关资源或缺乏这些能力。
Responsiveness and synchrony in dyadic interactions with significant others are crucial for healthy interpersonal relations. 与重要他人的互动中的反应性和同步性对健康的人际关系至关重要。
A stronger therapeutic focus on the patient's capacity to show synchrony in dyadic attachment situations might improve the patient's interpersonal problems towards sensitive and mutual interaction. 更加强调治疗患者在双人依恋情境中表现出同步的能力，可能会改善患者在敏感和相互互动方面的人际问题。
