Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T08:12:00.084Z Has data issue: false hasContentIssue false
  • English
  • Français

Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder

Published online by Cambridge University Press:  28 August 2013

K. L. Gratz ,
M. T. Tull  and
R. Levy
K. L. Gratz*
Affiliation:
Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
M. T. Tull
Affiliation:
Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
R. Levy
Affiliation:
T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
*
*Address for correspondence: Dr K. L. Gratz, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Despite the clinical importance of deliberate self-harm (DSH; also referred to as non-suicidal self-injury) within borderline personality disorder (BPD), empirically supported treatments for this behavior among individuals with BPD are difficult to implement in many clinical settings. To address this limitation, a 14-week, adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD was developed. The current study examined the efficacy of this ERGT in a randomized controlled trial (RCT) and the durability of treatment gains over a 9-month uncontrolled follow-up period.

Method

Female out-patients with BPD and recent recurrent DSH were randomly assigned to receive this ERGT in addition to their ongoing out-patient therapy immediately (n = 31) or after 14 weeks (n = 30). Measures of DSH and other self-destructive behaviors, psychiatric symptoms, adaptive functioning and the proposed mechanisms of change (emotion dysregulation/avoidance) were administered pre- and post-treatment or -waitlist (to assess treatment efficacy), and 3 and 9 months post-treatment (to assess durability of treatment gains).

Results

Intent-to-treat (ITT) analyses (n = 61) revealed significant effects of this ERGT on DSH and other self-destructive behaviors, emotion dysregulation, BPD symptoms, depression and stress symptoms, and quality of life. Analyses of all participants who began ERGT (across treatment and waitlist conditions; n = 51) revealed significant improvements from pre- to post-treatment on all outcomes, additional significant improvements from post-treatment to 9-month follow-up for DSH, emotion dysregulation/avoidance, BPD symptoms and quality of life, and no significant changes from post-treatment to 9-month follow-up on the other measures.

Conclusions

The results support the efficacy of this ERGT and the durability of treatment gains.

Keywords

Borderline personalityemotion regulationgroupself-harmself-injurytreatment
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 10 , July 2014 , pp. 2099 - 2112
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bateman, A, Fonagy, P (2004). Mentalization-based treatment of BPD. Journal of Personality Disorders 18, 36–51.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX.Google Scholar
Blanchard, EB, Appelbaum, KA, Radnitz, CL, Michultka, D, Morrill, B, Kirsch, C, Hillhouse, J, Evans, DD, Guarnieri, P, Attanasio, V, Andrasik, F, Jaccard, J, Dentinger, MP (1990). Placebo controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. Journal of Consulting and Clinical Psychology 58, 210–215.CrossRefGoogle ScholarPubMed
Borkovec, TD, Nau, SD (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry 3, 257–260.CrossRefGoogle Scholar
Chapman, AL, Gratz, KL, Brown, MZ (2006). Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behaviour Research and Therapy 44, 371–394.CrossRefGoogle ScholarPubMed
Chou, C-P, Yang, D, Pentz, MA, Hser, Y-I (2004). Piecewise growth curve modeling approach for longitudinal prevention study. Computational Statistics and Data Analysis 46, 213–225.CrossRefGoogle Scholar
Clifton, A, Pilkonis, PA (2007). Evidence for a single latent class of Diagnostic and Statistical Manual of Mental Disorders borderline personality pathology. Comprehensive Psychiatry 48, 70–78.Google Scholar
Devilly, GJ, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry 31, 73–86.CrossRefGoogle ScholarPubMed
Diefenbach, GJ, Abramowitz, JS, Norberg, MM, Tolin, DF (2007). Changes in quality of life following cognitive-behavioral therapy for obsessive-compulsive disorder. Behaviour Research and Therapy 45, 3060–3068.CrossRefGoogle ScholarPubMed
Enders, CK (2010). Applied Missing Data Analysis. Guilford Press: New York.Google Scholar
Espie, CA, Inglis, SJ, Harvey, L (2001). Predicting clinically significance response to cognitive behavior therapy for chronic insomnia in general medical practice: analysis of outcome data at 12 months posttreatment. Journal of Consulting and Clinical Psychology 69, 58–66.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P, Version 2.0). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Fliege, H, Kocalevent, R, Walter, OB, Beck, S, Gratz, KL, Gutierrez, P, Klapp, BF (2006). Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates. Journal of Psychosomatic Research 61, 113–121.Google Scholar
Frisch, MB, Cornwell, J, Villanueva, M, Retzlaff, PJ (1992). Clinical validation of the Quality of Life Inventory: a measure of life satisfaction of use in treatment planning and outcome assessment. Psychological Assessment 4, 92–101.Google Scholar
Gratz, KL (2001). Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment 23, 253–263.CrossRefGoogle Scholar
Gratz, KL, Gunderson, JG (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy 37, 25–35.Google Scholar
Gratz, KL, Levy, R, Tull, MT (2012). Emotion regulation as a mechanism of change in an acceptance-based emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Journal of Cognitive Psychotherapy 26, 365–380.CrossRefGoogle Scholar
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 41–54.CrossRefGoogle Scholar
Gratz, KL, Rosenthal, MZ, Tull, MT, Lejuez, CW, Gunderson, JG (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology 115, 850–855.Google Scholar
Gratz, KL, Tull, MT (2010). Emotion regulation as a mechanism of change in acceptance- and mindfulness-based treatments. In Assessing Mindfulness and Acceptance: Illuminating the Processes of Change (ed. Baer, R. A.), pp. 107–134. New Harbinger Publications: Oakland, CA.Google Scholar
Gratz, KL, Tull, MT (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personality Disorders: Theory, Research, and Treatment 2, 316–326.Google Scholar
Hambrick, JP, Turk, CL, Heimberg, RG, Schneier, FR, Liebowitz, MR (2004). Psychometric properties of disability measures among patients with social anxiety disorder. Journal of Anxiety Disorders 18, 825–839.CrossRefGoogle ScholarPubMed
Hardy, SA, Thiels, C (2009). Using latent growth curve modeling in clinical treatment research: an example comparing guided self-change and cognitive behavioral therapy treatments for bulimia nervosa. International Journal of Clinical and Health Psychology 9, 51–71.Google Scholar
Hayes, SC, Strosahl, KD, Wilson, KG (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press: New York.Google Scholar
Hayes, SC, Strosahl, K, Wilson, KG, Bissett, RT, Pistorello, J, Toarmino, D, Polusny, MA, Dykstra, TA, Batten, SV, Bergan, J, Stewart, SH, Zvolensky, MJ, Eifert, GH, Bond, FW, Forsyth, JP, Karekla, M, McCurry, SM (2004). Measuring experiential avoidance: a preliminary test of a working model. The Psychological Record 54, 553–578.Google Scholar
International Society for the Study of Self-injury (ISS) (2007). Definitional Issues Surrounding our Understanding of Self-Injury. Conference proceedings from the annual meeting of the International Society for the Study of Self-injury (http://www.isssweb.org/aboutnssi.php).Google Scholar
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.CrossRefGoogle ScholarPubMed
Lee, SY, Song, XY (2004). Evaluation of Bayesian and maximum likelihood approaches in analyzing structural equation models with small samples. Multivariate Behavioral Research 39, 653–686.Google Scholar
Lejuez, CW, Daughters, SB, Nowak, JA, Lynch, T, Rosenthal, MZ, Kosson, D (2003). Examining the Inventory of Interpersonal Problems as a tool for conducting analogue studies of mechanisms underlying borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry 34, 313–324.Google Scholar
Linehan, MM (1993). Cognitive–Behavioral Treatment of Borderline Personality Disorder. Guilford Press: New York.Google Scholar
Linehan, MM, Comtois, KA (1996). Lifetime Parasuicide Count. University of Washington: Seattle, WA.Google Scholar
Linehan, MM, Heard, HL (1987). Treatment History Interview. University of Washington: Seattle, WA.Google Scholar
Lovibond, SH, Lovibond, PF (1995). Manual for the Depression Anxiety Stress Scales, 2nd edn. The Psychology Foundation of Australia: Sydney.Google Scholar
Muthén, LK, Muthén, BO (1998–2010). Mplus User's Guide, 6th edn. Muthén & Muthén: Los Angeles, CA.Google Scholar
Nock, MK (2009). Why do people hurt themselves? New insights into the nature and functions of self-injury. Current Directions in Psychological Science 18, 78–83.CrossRefGoogle ScholarPubMed
Ogles, BM, Lunnen, KM, Bonesteel, K (2001). Clinical significance: history, application, and current practice. Clinical Psychology Review 21, 421–446.Google Scholar
Pfohl, B, Blum, N, St John, D, McCormick, B, Allen, J, Black, DW (2009). Reliability and validity of the Borderline Evaluation of Severity over Time (BEST): a self-rated scale to measure severity and change in persons with borderline personality disorder. Journal of Personality Disorders 23, 281–293.Google Scholar
Roemer, L (2001). Measures of anxiety and related constructs. In Practitioner's Guide to Empirically Based Measures of Anxiety (ed. Antony, M. M., Orsillo, S. M. and Roemer, L.), pp. 49–83. Kluwer Academic/Plenum: New York.Google Scholar
Roemer, L, Orsillo, SM (2007). An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy 38, 72–85.CrossRefGoogle ScholarPubMed
Safer, DL, Telch, CF, Chen, EY (2009). Dialectical Behavior Therapy for Binge Eating and Bulimia. Guilford Press: New York.Google Scholar
Sansone, RA, Wiederman, MW, Sansone, LA (1998). The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. Journal of Clinical Psychology 54, 973–983.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
Selby, EA, Joiner, TE (2009). Cascades of emotion: the emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology 13, 219–229.Google Scholar
Sheehan, DV (1983). The Anxiety Disease. Charles Scribner and Sons: New York.Google Scholar
Thayer, JF, Lane, RD (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders 61, 201–216.CrossRefGoogle Scholar
Tyrer, P, Tom, B, Byford, S, Schmidt, U, Jones, V, Davidson, K, Knapp, M, MacLeod, A, Catalan, J; POPMACT Group (2004). Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT Study. Journal of Personality Disorders 18, 102–116.Google Scholar
Zanarini, MC (2003). Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. Journal of Personality Disorders 17, 233–242.CrossRefGoogle ScholarPubMed
Zanarini, MC (2009). Psychotherapy of borderline personality disorder. Acta Psychiatrica Scandinavica 120, 373–377.Google Scholar
Zanarini, MC, Frankenburg, FR, Sickel, AE, Young, L (1996). Diagnostic Interview for DSM-IV Personality Disorders. McLean Hospital: Boston, MA.Google Scholar
Zhang, Z, Hamagami, F, Wang, L, Nesselroade, JR (2007). Bayesian analysis of longitudinal data using growth curve models. International Journal of Behavioral Development 31, 374–383.Google Scholar
Supplementary material: File

Gratz Supplementary Material

Fig

Download Gratz Supplementary Material(File)
File 115.2 KB