Riegler Alisa, Bumb Jan Malte, Wisch Christian, Schuster Rilana, Reinhard Iris, Hoffmann Sabine, Frischknecht Ulrich, Enning Frank, Schmahl Christian, Kiefer Falk, Koopmann Anne
Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Feuerlein Center on Translational Addiction Medicine (FCTS), Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Eur Addict Res. 2023;29(1):1-8. doi: 10.1159/000526670. Epub 2022 Oct 10.
Borderline personality disorder (BPD) is one of the most common personality disorders among persons with substance use disorders (SUDs) and is characterized by severe clinical symptoms. The aim of this study was to investigate if the effect of dialectical behavior therapy for substance use disorders (DBT-S) inpatient treatment on psychopathological symptom load in patients suffering from both BPD and SUD can be augmented by weekly 60-min "Trauma Informed Hatha Yoga" sessions.
Thirty-nine patients suffering from comorbid BPD and SUD were consecutively in time included in this quasi-experimental pilot study (first intervention then control group). In the intervention group, weekly Trauma Informed Hatha Yoga sessions were added to standard DBT-S for 8 weeks. The participants of the control group received standard DBT-S. All participants completed several self-report questionnaires to assess symptoms of depression, anxiety, symptoms of BPD, and their subjective stress perception at three points in time during the study course.
A repeated measures analysis of variance with patients' psychopharmacological medication as covariate revealed a significant main effect of time for each of the psychometric scales (State and Trait Anxiety Inventory subscale for state anxiety [STAI-S] p = 0.001, Beck Depression Inventory [BDI] p < 0.001; Borderline Symptom List 23 [BSL] p = 0.036) indicating that the psychopathological symptom load of the patients was significantly lower at the end of the DBT-S therapy compared to the beginning in both study groups. Moreover, there was a significant interaction effect of group*time on the psychometric scales STAI-T (subscale for trait anxiety) sum score (p = 0.010) and the sum score of the Perceived Stress Scale (PSS) (p = 0.043). This was expressed by the fact that the participants of the intervention group showed a significant reduction of the STAI-T sum score as well as the sum score of the Perceived Stress Scale (PSS), while the control group did not. Due to the exploratory nature of this study, correction for multiple testing was omitted.
Although they are very preliminary, our results suggest that practicing Trauma Informed Hatha Yoga on a regular basis in addition to DBT-S inpatient treatment seems to reduce the level of trait anxiety and perceived stress significantly more than DBT-S inpatient treatment alone. Nevertheless, the effectiveness of Trauma Informed Hatha Yoga in reducing trait anxiety and perceived stress in patients suffering from SUD und BPD must be tested in large randomized controlled trials.
边缘型人格障碍（BPD）是物质使用障碍（SUDs）患者中最常见的人格障碍之一，其特点是临床症状严重。本研究的目的是调查，对于同时患有BPD和SUD的患者，在物质使用障碍辩证行为疗法（DBT-S）住院治疗基础上，每周60分钟的“创伤知情哈他瑜伽”课程是否能增强其对心理病理症状负荷的治疗效果。
本准实验性试点研究连续纳入了39例同时患有BPD和SUD的患者（先干预组后对照组）。干预组在标准DBT-S治疗基础上，每周增加创伤知情哈他瑜伽课程，为期8周。对照组患者接受标准DBT-S治疗。所有参与者在研究过程中的三个时间点完成了几份自我报告问卷，以评估抑郁症状、焦虑症状、BPD症状及其主观压力感知。
以患者的心理药物治疗作为协变量的重复测量方差分析显示，每个心理测量量表在时间上都有显著的主效应（状态焦虑特质焦虑量表状态焦虑分量表[STAI-S] p = 0.001，贝克抑郁量表[BDI] p < 0.001；边缘症状清单23[BSL] p = 0.036），表明与治疗开始时相比，两个研究组在DBT-S治疗结束时患者的心理病理症状负荷均显著降低。此外，在心理测量量表STAI-T（特质焦虑分量表）总分（p = 0.010）和感知压力量表（PSS）总分（p = 0.043）上，组*时间存在显著的交互作用。这表现为干预组参与者的STAI-T总分以及感知压力量表（PSS）总分显著降低，而对照组则没有。由于本研究的探索性性质，未进行多重检验校正。
尽管结果非常初步，但我们的研究结果表明，在DBT-S住院治疗基础上定期练习创伤知情哈他瑜伽，似乎比单独的DBT-S住院治疗能更显著地降低特质焦虑水平和感知压力。然而，创伤知情哈他瑜伽在降低SUD和BPD患者特质焦虑和感知压力方面的有效性，必须在大型随机对照试验中进行检验。
