Soler Joaquim, Casellas-Pujol Elisabet, Pascual Juan Carlos, Schmidt Carlos, Domínguez-Clavé Elisabet, Cebolla Ausias, Alvear David, Muro Anna, Elices Matilde
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.
Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Borderline Personal Disord Emot Dysregul. 2022 Dec 12;9(1):34. doi: 10.1186/s40479-022-00204-x.
Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties.
This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability.
The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%.
The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.
边缘型人格障碍（BPD）患者的长期随访研究一致表明，尽管症状往往会随着时间推移而减轻，但社会心理适应方面的损害仍然持续存在。因此，或许最好不要过于强调以症状为导向的干预措施，而是推广纳入患者康复观点的干预措施。在本研究中，我们旨在检验一种新型干预措施（辩证行为疗法结合积极心理学和基于情境的技能）在临床治疗长期存在的BPD问题中的可行性和可接受性。
这是一项定性研究。我们为长期存在的BPD制定了一个为期8周的初始团体干预方案。在8周方案结束后，要求参与者参加小组讨论以提供反馈。根据该反馈，对干预方案进行修改，然后提供给第二组患者，他们也提供了反馈。方案再次修订后应用于第三组。共有32名患者参与了团体干预；其中20名在定性研究中提供了反馈。主要结局指标是可接受性。
小组访谈中出现了以下总体主题：有益、无益和中性的做法；内部/外部障碍；促进因素；以及效果。参与者报告在设想理想未来和自我同情方面存在困难。相比之下，积极技能与积极情绪的增加相关。主要的内部障碍是面对困难情绪。主要的外部障碍是与语言相关的问题。团体形式被视为成功的促进因素。作为可接受性的一项额外衡量指标的退出率在每个连续的组中大幅下降，从60%降至40%，最终降至20%。
该干预措施在临床环境中实施是可行的，参与者对最终的技能集评价很高。大多数技能被认为是有用的。参与者的反馈对于改进干预措施非常宝贵，留存率从40%大幅提高到80%就证明了这一点。需要进行随机临床试验来检验这种干预措施在促进长期存在BPD的参与者幸福感方面的疗效。
