Personality Disorders

Reduce Self-Harm in Patients with Borderline Personality Disorder with Mindfulness

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Reduce Self-Harm in Patients with Borderline Personality Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Dialectical Behavior Therapy group skills training was associated with a reduction in non-suicidal self-injury in patients with Borderline Personality Disorder.” – Gary Rothbard

 

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways. Nearly 50 percent of those who engage in self-injury have been sexually abused.

 

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. About ¾ of BPD patients engage in self-injurious behaviors.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. DBT reduces self-injurious behaviors in BPD patients.

 

In today’s Research News article “Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952764/ ) Westad and colleagues recruited adults with subthreshold Borderline Personality Disorder (BPD) and provided them with 1 hour individual therapy and 2.5 hours of group skills training per week for 8 weeks of Dialectical Behavior Therapy (DBT). Prior to treatment they were assessed for personality and clinical symptoms. Before and after treatment they were measured for self-harm and suicidal behaviors, depression, hopelessness, personality disorders, quality of life, general health, and psychological, social, and occupational functioning.

 

They found that over the first year following therapy 94% of the patients ceased self-harm behaviors in an average of 16 weeks. Compared to baseline, following treatment the patients had significant increases in quality of life and functioning and significant decreases in depression, hopelessness, and personality disorders. A comparison of patients who reduced self-harm behaviors quickly to those who took longer for the reduction did not reveal any significant differences.

 

In the present study there wasn’t a control condition. So, alternative confounding interpretations are present. But the findings replicate previous controlled work that Dialectical Behavior Therapy (DBT) produces significant improvement in Borderline Personality Disorder and reductions in self-harm behaviors. So, the results of the present study are likely to due to DBT alone. The findings expand knowledge in that they demonstrate the effectiveness of DBT for patients who are subthreshold for BPD.

 

Dialectical Behavior Therapy (DBT) is one of very few treatments that are effective for Borderline Personality Disorder (BPD). But DBT is a complex therapy that includes mindfulness and other significant components. So, it is unclear which components or combination of components are necessary and sufficient for the clinical benefits.

 

So, reduce self-harm in patients with borderline personality disorder with mindfulness.

 

“DBT might provide an effective treatment for severe self-harm in institutional settings.” – Gail Skillington

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are a also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Yngvill Ane Stokke Westad, Kristen Hagen, Egil Jonsbu, Stian Solem. Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy, Front Psychol. 2021; 12: 578230. Published online 2021 Feb 26. doi: 0.3389/fpsyg.2021.578230

 

Abstract

The first aim of the study was to identify when deliberate self-harm (DSH) behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment (DBT). The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early (up to 8 weeks) and late (8+ weeks) responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority (93.5%) ceased their self-harming within the first year, and the average number of weeks was 15.5 (SD = 17.8). Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952764/

 

Spirituality is Associated with Improved Psychological Well-Being in Patients with Persistent Mental Illness

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Spirituality is Associated with Improved Psychological Well-Being in Patients with Persistent Mental Illness

 

By John M. de Castro, Ph.D.

 

“No cure that fails to engage our spirit can make us well.” – Victor Frankl

 

Religion and spirituality have been promulgated as solutions to the challenges of life both in a transcendent sense and in a practical sense. What evidence is there that these claims are in fact true? The transcendent claims are untestable with the scientific method. But the practical claims are amenable to scientific analysis. There have been a number of studies of the influence of religiosity and spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. But there is still a need to investigate the relationships of spirituality with psychological well-being in patients with persistent mental illness.

 

In today’s Research News article “Spirituality and Employment in Recovery from Severe and Persistent Mental Illness and Psychological Well-Being.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827133/ ) Saiz and colleagues recruited adult patients with persistent mental illness who were in a program to prepare them for employment. The disorders included psychoses, schizophrenia, personality disorders, and mood disorders. The patients completed questionnaires measuring stage of recovery, hope, self-determination, psychological well-being, including self-acceptance, positive relationships, autonomy, environmental mastery, personal growth and purpose in life subscales, employment, work motivation including of satisfaction, integration into the work environment, social acceptance, social performance, job skills, self-esteem, perception of family support and job assertiveness subscales, spiritual experiences and spiritual well-being.

 

They report that the higher the levels of spirituality and work motivation, the higher the levels of psychological well-being and recovery. When spirituality and work motivation were used together as predictors of recovery only spirituality was significantly related. Similarly, when spirituality and work motivation were used together as predictors of psychological well-being only spirituality was significantly related. Hence, when work motivation is considered, only spirituality is significantly related to psychological well-being and recovery.

 

These findings for patients with persistent mental illness make sense as spirituality has been found in the past with other groups to be associated with psychological well-being and better mental health. The findings, though, are correlational and as such causation cannot be determined. Only that spirituality is associated with to psychological well-being and recovery can be ascertained. But this association is potentially important and suggests that the promotion of spirituality may be beneficial for patients with persistent mental illness, helping them recover better and be psychologically healthier. This remains for future research.

 

So, spirituality is associated with improved psychological well-being in patients with persistent mental illness.

 

“many people with mental illness desire the incorporation of spirituality in their recovery process/treatment.” – Jan-Stella Metheany

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are aalso available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Saiz, J., Galilea, M., Molina, A. J., Salazar, M., Barsotti, T. J., Chopra, D., & Mills, P. J. (2021). Spirituality and Employment in Recovery from Severe and Persistent Mental Illness and Psychological Well-Being. Healthcare (Basel, Switzerland), 9(1), 57. https://doi.org/10.3390/healthcare9010057

 

Abstract

People diagnosed with severe and persistent mental illness (SPMI) face multiple vulnerabilities, including when seeking employment. Among SPMI patients, studies show that a stronger sense of spirituality can help to reduce psychotic symptoms, increase social integration, reduce the risk of suicide attempts and promote adherence to psychiatric treatment. This study examined how the variables spirituality and employment affect the recovery process and psychological well-being of people with SPMI who attend employment recovery services. The sample consisted of 64 women and men diagnosed with an SPMI. The assessment instruments included the Recovery Assessment Scale, Ryff Psychological Well-Being Scale, Work Motivation Questionnaire, Daily Spiritual Experience Scale, and Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp12). Hierarchical regression analyses were performed to compare three different models for each dependent variable (recovery and psychological well-being). The findings showed that job skills predicted psychological well-being and recovery. When spiritual variables were included in the model, job skills dropped out and the dimension meaning/peace of the FACIT-Sp12 emerged as the only significant predictor variable. Integrating spirituality into recovery programs for people with SPMI may be a helpful complement to facilitate the recovery process and improve psychological well-being.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827133/