By John M. de Castro, Ph.D.
“One problem that clients with borderline personality disorder face is that their behaviors are often ruled by emotions. This frequently leads to destructive behaviors such as drug use, risky sexual encounters, and self-injury. The goal of mindfulness as used in DBT is to get patients to recognize these patterns so they can act more thoughtfully.” – Christina Olenchek
Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. In addition, 30 to 90 % of BPD cases are associated with high rates of early traumatic experiences including sexual, physical and emotional abuse. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives. Needless to say it is widespread, debilitating, and markedly reduces health and health related quality of life.
BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder and impulsivity. The effectiveness of DBT has been only demonstrated in adults. But Borderline Personality Disorder (BPD) also can occur in adolescents. But, it is not known if DBT may be effective for adolescents with BPD and can improve their health and quality of life.
In today’s Research News article “Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot.” See:
or see summary below or view the full text of the study at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954798/
Swales and colleagues received and summarized data from 4 different programs that administered Dialectical Behavior Therapy (DBT) to adolescents with Borderline Personality Disorder (BPD). They obtained health status data including mobility, self-care, usual activities, pain or discomfort and anxiety and depression. They found that DBT produced a significant improvement in health status and health related quality of life with a clinically significant large effect size. Comparison of these results to those obtained in other studies with adults indicated that the results for the adolescents were comparable or better.
These are interesting findings but they suffer from the lack of a control comparison condition. It should be kept in mind, however, that Borderline Personality Disorder (BPD) rarely improves even with other forms of treatment. So, it is unlikely that these youths spontaneously got better or responded to a placebo effect. The results are important in that they demonstrate for the first time that DBT is effective for BPD in adolescents, improving their health and health related quality of life. Hence, mindfulness training appears to be an important of successful treatment of Borderline Personality Disorder (BPD) in adolescents.
So, improve quality of life in borderline patients with mindfulness.
“Many people with BPD have comorbid conditions, which often include mood disorders, anxiety disorders, or substance-use disorders. Studies show that mindfulness helps for many of these.” – Blaise Aguirre
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Swales, M., Hibbs, R. A. B., Bryning, L., & Hastings, R. P. (2016). Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot. SpringerPlus, 5(1), 1137. http://doi.org/10.1186/s40064-016-2826-9
Abstract
Purpose: Adults presenting with borderline personality disorder (BPD) score poorly on measures of health related quality of life (HRQoL). Little is known about HRQoL in adolescents with BPD type presentations and how treatment impacts quality of life. Our primary aim was to use routinely collected quality-of-life outcome measures pre and post-treatment in dialectical behaviour therapy (DBT) for adolescents to address this gap. Secondary aims were to benchmark these data against EuroQol 5 dimensions (EQ-5D™) outcomes for clients treated in clinical trials and to assess the potential of the EQ-5D™ as a benchmarking tool.
Method: Four adolescent DBT teams, routinely collecting outcome data using a pseudonymised secure web-based system, supplied data from consecutive discharges.
Results: Young people in the DBT programmes (n = 43) had severely impaired HRQoL scores that were lower at programme admission than those reported in published studies using the EQ-5D™ in adults with a BPD diagnosis and in one study of adolescents treated for depression. 40 % of adolescents treated achieved Reliable Clinical Change. HRQoL improved between admission and discharge with a large effect size. These results were not statistically significant when clustering in programme outcomes was accounted for.
Conclusion: Young people treated in NHS DBT programmes for BPD type presentations had poorer HRQoL than adults with a BPD diagnosis and adolescents with depression treated in published clinical trials. The EQ-5D™ detected reliable change in this group of adolescents. Programme outcome clustering suggests that both the measure and the web-based monitoring system provide a mechanism for benchmarking clinical programmes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954798/