Thesis: Combined Therapy for Borderline Personality Disorder

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Running Head: COMBINED THERAPY FOR BDP

Treatment of Borderline Personality Disorder with
Combined Dialectical Behavior Therapy
and Motivational Enhancement Therapy

Catherine Lau 20270609
Thursday December 9, 2010
Course Code: Psych 397 Section 1
Research methods in Personality and Clinical Psychology
Professor Jeffrey Paulizki
University of Waterloo

Abstract
A 10 month randomized clinical research trial on subjects who have borderline personality disorder (BPD) was conducted to compare the effectiveness of Dialectical Behavior Therapy (DBT) to a combination of DBT and Motivational Enhancement Therapy (MET). Therapies were evaluated with the Shedler–Westen Assessment Procedure, Self-Apperception Test, and with the Mental Illness Research, Education, and Clincial Centres Global Assessment of Functioning Scale. Results were examined using repeated measure analysis of variance. There was a significant effect of combined therapy on the SAT correlation score for the experimental group, and there was a significant effect of only DBT on the SAT correlation score for the control group. In the control group, there was a significant change of SAT correlation scores between T1 and T3. In the experimental group, there was no significant change between T1 and T2, however there was a significantly more dramatic change between T2 and T3. Combined therapy of DBT and MET is slower to have a positive effect, however, if the client stays with the therapy method, it is significantly more effective than only MET treatment.

Treatment of Borderline Personality Disorder with Combined Dialectical Behavior Therapy and Motivational Enhancement Therapy DBT effectively teaches patients how to behave when faced with stressful interpersonal or psychological situations when they arise so they can prevent self harm. However, DBT does not prevent the core problem that causes BPD patients to face undesirable situations. A randomized clinical trial of DBT on chronically para-suicidal women resulted in fewer incidents and severity of self harm. Partial hospitalization decrease para-suicidal behavior and feelings of depression, increased interpersonal function (Tyrer, 2002). However, there was no difference in feelings of depression, hopelessness, suicidal ideation, or reasons for living between the treatment group and the control group (Levy et al, 2010). These trials assume that behavior is the mediator for the mechanism that drives para-suicide. Perhaps stress is simply the moderator influencing the relationship between behaviors and coping mechanisms (para-suicide) and there is a deeper underlying problem: maladaptive emotional coping mechanisms. A randomized controlled trial of DBT on drug-dependent women who have BPD showed that therapy significantly reduced drug abuse and increased interpersonal and global adjustment problems for people who have BPD. However, the selection criteria of these studies neglect the common appearance of co-morbid disorders in those who have BPD (Linehan et al, 1980). BPD symptoms are also seen in Axis I and Axis II disorders; DBT may simply be effective in treating para-suicide or lethal impulsivity problems rather than BPD. DBT does not target distinct BPD symptoms such as interpersonal instability, chronic feelings of emptiness or boredom, and identity disturbance. Erratic moods, self harm, and impulsivity may be a coping mechanism for fear of unstable relationships, feelings of lack of control, and boredom; fluctuations in identity, boredom, and emptiness may be related to impulsivity problems. The purpose of this clinical trial was to determine the effectiveness of a combined therapy of DBT with MET for those with BPD, compared with results from only DBT. The combination therapy targeted specific BPD symptoms; the main objective was to prevent reoccurrence of BPD symptoms and minimize the cause for stressful events. The focus of MET was to eliminate symptoms that were not...
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