Psychological Treatments for Personality Disorders Flashcards
Understand attachment theory and the role of attachment in the development of good mental health Understand the process of mentalising and how problems with mentalising can lead to poor mental health Describe the main evidence-based psychological treatments for borderline personality disorder
Describe the 3 affective criteria in the DSM-IV criteria for borderline personality disorder
Inappropriate sense of anger, chronic feelings of emptiness, affective instability
Describe the 2 cognitive criteria in the DSM-IV criteria for borderline personality disorder
Transient paranoid ideation, identity disturbance
Describe the 2 behavioural criteria in the DSM-IV criteria for borderline personality disorder
Recurrent suicidal behaviour or threats, impulsively harmful act other than suicidal behaviour
Describe the 2 interpersonal criteria in the DSM-IV criteria for borderline personality disorder
Frantic efforts to avoid abandonment, unstable and intense interpersonal relationships
State some challenges in delivering psychological treatments for borderline personality disorder
Lack of trust and engagement, affective instability and lack of commitment, unstable relationships and lack of motivation, patient worries about treatment ending
Give some advantages of a personality disorder diagnosis
Gives the individual and their family an explanation, enables access to treatment, ensures individual doesn’t receive treatment for something they don’t have (e.g. psychosis)
Give some disadvantages of a personality disorder diagnosis
Undermines personal responsibility, creates dependency, diverts limited resources away from others who may need them, suggests there is a ‘right’ personality, stigma
Define fundamental attribution error
The tendency for people to place an undue emphasis of internal characteristics to explain someone else’s behaviour in a situation, rather than considering the situation’s external factors
Define mentalisation
The act of interpreting the actions of oneself and others as meaningful on the basis of intentional mental states - e.g. needs, desires, and beliefs. This can be unconscious and implicit (mirroring), or conscious and explicit (interpreting)
What is contingent mirroring?
When the caregiver accurately matches the infant’s mental state in their internal representation, rather than projecting their own feelings onto the infant
What is incongruent mirroring?
When the caregiver’s internal representation of the infant’s mental state does not correspond to the infant’s actual mental state
What is unmarked mirroring?
When the caregiver’s internal representation of the infant’s mental state is an externalisation of their own thoughts, rather than representing the infant
Describe the effect of inappropriate mirroring on an infant
It can lead to disruption of the infant’s sense of self
When is the ability to mentalise disrupted?
Mental illness, when intoxicated, and in states of heightened emotional arousal (e.g. new relationships, close relationships)
State the general features of psychological treatment plans for personality disorder
Assessment, creation of boundaries and flexibility, validation, crisis planning, team work, communication
What is mentalisation based treatment (MBT)
A modified psychoanalytic psychotherapy focusing on tounter-transference, tolerance of anxiety, and interpretation, promoting mentalisation and living in the present.
How long does mentalisation based treatment for personality disorder last?
18 months, with twice weekly sessions that are a mixture of individual and group
Describe the basic mentalisation approach advocated in mentalisation based treatment
Stop, look, listen - appraising a situation, highlighting who feels what and appreciating multiple perspectives, and understanding why reactions occur
Describe the evidence for mentalisation based treatment (Bateman & Fonagy, 2009)
MBT produces markedly superior outcomes to treatment as usual. It reduces suicide attempts, self-harm, and inpatient care, and improves mental health and social function
What is a schema?
How people organise and make sense of their work
How can a schema cause maladaptive cognitions?
Maladaptive thoughts develop when an individual’s schema does not fit with a change in context - e.g. dependent cognitions develop when an individuak’s schema makes them feel helpless, and paranoid cognitions develop when a schema makes them see others as a threat (e.g. due to child abuse)
Describe schema-focused therapy
A type of modified CBT lasting 18-24 months with twice-weekly sessions aiming to explore schemas and higher-order cognitive processes
Describe the evidence for schema focused therapy for borderline personality disorder
3 RCTs have shown it is cost-effective and may be more affective than psychodynamic psychotherapy
Name the 3 areas which dialetical behaviour therapy aims to develop
Mindfulness, interpersonal effectiveness (asking for what one needs, saying no, and coping with interpersonal conflict), and distress tolerance
Define mindfulness
The capacity to non-judgementally pay attention to the present moment and live in the moment
State the 2 key concepts of dialectical behaviour therapy
Validation and dialectics
Define dialectics
The inter-related nature of actions and behaviour, acknowledging how hard it can be to change established patterns of behaviour
Describe the aims of dialectical behaviour therapy
Teach new skills (e.g. mindfulness, emotion regulation, distress tolerance), reduce distraction and mind-wandering, and enhance motivation
Describe the evidence for dialectical behaviour therapy
8 RCTS have shown it causes a marked reduction in self-harm and some reduction in emotional distress - but the largest trial (McMain, 2009) found no difference between DBT and high-quality general psychiatric care
State the NICE recommendations for treating borderline personality disorder
Avoid treatments of short-term duration, use an explicit and integrated approach, adapt frequency to needs with twice-weekly sessions considered, for women with BPD and serious self-harm consider DBT
Describe the attrition rate of psychological treatment for borderline personality disorder
50% do not engage with treatment, and 30% of those that do drop out before completion
Describe problem solving therapy
A 12-session group intervention designed to help participants learn how to process and solve interpersonal problems
Describe the results of a study into problem solving therapy for personality disorder
It was halted by the DMEC due to higher rates of suicide in individuals receiving problem solving therapy - although the relative risk of adverse events was not statistically significant
Why might problem solving therapy be ineffective for borderline personality disorder?
It is too short an intervention and does not change the patients’ existing schema
