Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia.
School of Education, Western Sydney University, Penrith, Australia.
PLoS One. 2021 Jul 27;16(7):e0255055. doi: 10.1371/journal.pone.0255055. eCollection 2021.
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.
边缘型人格障碍（BPD）是一种普遍且严重的心理健康状况。人们在接受 BPD 的心理治疗后可以康复或缓解；然而，据估计，在精心设计的治疗试验中，约有 45%的人对当前的心理治疗反应不足。
通过确定导致反应不足问题的因素，进一步推进 BPD 的心理治疗。
对 184 名连续的社区治疗中的 BPD 患者进行自然随访 12 个月，并检查人格和社会功能的测量。使用逻辑回归确定哪些基线因素与 12 个月心理治疗后成为无反应者的可能性相关。12 个月后，根据可靠变化指数（RCI）方法，由于 BPD 症状没有减少，48.4%的参与者被归类为无反应者。
在基线摄入时，那些认同成人占据依恋关系风格和增加愤怒的患者更有可能在 12 个月时成为 BPD 症状的无反应者。此外，在成年期关系中存在占据依恋模式的患者在随访时更有可能在一般心理困扰方面成为无反应者。较高的偏执基线水平和对轻视成年关系风格的认可与在整体功能方面成为无反应者相关。
与之前的研究一致，近一半的样本在 12 个月随访时没有达到可靠的变化。一种以占据性不安全感和高愤怒为特征的关系风格似乎在从心理治疗中获益方面特别具有挑战性。这种风格可能既影响到外部关系，也影响到治疗内部，使治疗参与和与治疗师的联盟变得复杂。根据这些关系风格的挑战，早期识别和修改治疗可能是改善 BPD 心理治疗结果的一种方法。
