Lecture 22 PD Treatment Flashcards
transactional model of Borderline PD
emotion dysretulation invalidating response style
emotion vulnerability (sensitivity, reactivity, slow return to baseline)
->
heightened emotional arousal (increased likelihood of emotion dysregulation)
->
inaccurate expression
->
invalidating response (from parents and others)
—->
feed back to heightented emotion
—->pervasive history of invalidating responses
———>emotion vulnerability
heightened emotional arousal
- sensitivity: more likely to notice emotional stimuli at a lower threshold
- reactivity: have a stronger emotional reaction
- slow return to baseline: take longer to return to baseline
level I & II evidence
level I: a meta-analysis or systematic review of level II studies that included a quantitative analysis
level II: a study of test accuracy with an independent, blinded comparison with a valid reference standard, among consecutive persons with a defined clinical presentation
treatments of BPD
Level I evidence:
DBT
schema therapy
psychodynamic psychotherapy
Level II evidence: acceptance and commitment therapy CBT interpersonal therapy psychoeducation
DBT
dialectic: a synthesis or integration of opposites
central dialectics of DBT: acceptance and change
behavioural reinforcement: using rewards to increase the likelihood of behaviour
goal of DBT: accepting oneself and current situation whilst changing behaviours causing suffering
to enhance behavioural, emotional, cognitive responses & interpersonal interactions
standards of full DBT
individual therapy (1hr/wk)
group skills training (2.5hrs/wk)
phone coaching as needed
therapist consultation team (1-1.5hrs/wk)
core skills modules of DBT
Mindfulness:
- Intentionally living with awarenessin the present moment: being awake and alert to participate and be present to our own lives
- Without judging or rejecting the moment: Noticing consequences and letting go of evaluating, avoiding or blocking
- Without attachment to the moment:Paying attention to each moment without ignoring the present by clinging to the past or grabbing for the future
- WISE MIND
Distress Tolerance
- survive crisis situations without making them worse
- accept reality, replace suffering and being “stuck” with ordinary pain and the possibility of moving forward
- become free of having to satisfy the demands of your own desires, urges, and intense emotions
Emotion Regulation
- Understand the emotions that you experience.
- Reduce emotional vulnerability and stop unwanted emotions from starting in the first place.
- Decrease emotional suffering; stop or reduce unwanted emotions once they start.
Interpersonal Effectiveness
- Keeping and maintaining healthy relationships
- Getting somebody to do what you want
- Maintaining Your Self-Respect
Schema Therapy and the evidence base
Meta-analytic findings have shown that Schema Therapy is effective in reducing borderline personality disorder pathology
-5 studies (case series, open trials, or randomized controlled trials (RCT) that used ST to treat BPD)
Randomized Control Trial findings of clinical efficacy for treating Cluster C, paranoid, histrionic and narcissistic personality disorders:
- 2 years of treatment
- Findings did not vary with specific personality disorder diagnosis
Schema Therapy
Individuals all have core emotional needs
Early maladaptive schemas are unconditional and problematic beliefs about oneself, significant others and environment.
Schemas arise in response to unmet emotional needs in childhood and adolescence; strengthened and elaborated throughout adulthood.
Comprised of thoughts, feelings, images, memories and physical responses.
dysfunctional coping modes
surrender
avoid
overcompensate
schema modes therapy
strengthen healthy adult
confront empathically, validate, discuss, reduce, set limits to dysfunctional coping modes
question, limit, stop parents
validate, comfort, get in touch with vulnerable child
