A Cognitive Approach in treating Borderline Personality Disorder
Psychological Intervention Models
Dr. Joe Beltempo, Ph.D
November 6th, 2013
Borderline personality disorder (BPD) is one of the most complicated disorders that a therapist has to face in his career. Much research has been done regarding treatments, but not many have been promising. In some instances, results were even deteriorative to the patient (Verheul et al., 2003). Research around several cognitive treatments has found contradicting results amongst mindfulness-based cognitive therapy, manual assisted cognitive treatment, cognitive-analytic therapy, dialectical behaviour therapy, and STEPPS group treatment. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) is the most widely accepted nomenclature used by clinicians and researchers for the classification of mental disorders. The DSM-5 suggests that BPD diagnosis must include five or more of the following symptoms: constant efforts in avoiding real or imagined abandonment from others, instability in interpersonal relationships, sudden shifts from idealization to devaluation of others, unstable identity and sense of self, impulsive behaviour in at least two areas (promiscuity, spending, binge eating...), pattern of deliberate self-harm, threats, or suicidal behaviour, unstable affect of which can be inappropriate, feelings of emptiness, difficulty in controlling moods, and severe dissociative symptoms. The prevalence rate for this disorder is approximately 2% of the population, with 75% being female (Frey, 2006, p. 2862-2867). Firstly, studies have been made around the mindfulness-based cognitive therapy for individuals with BPD. The Mindfulness-based cognitive therapy (MBCT) was initially created in order to prevent relapses in recurrent depression (Sachse, Keville, & Feigenbaum, 2011). The MBCT method is a combination of techniques found in cognitive therapy, and intensive techniques of mindfulness training. Mindfulness is characterized by meditation, and controlling the nature of thoughts and feelings, something that is lacking in patients with BPD. MBCT helps train individuals in developing coping skills, regulate negative emotions through attention control, and reduce depression relapses. The study found that BPD patients show signs of deficits in mindfulness skills and attention skills; they avoid unpleasant sensations and situations which might elicit these emotions instead of facing them. This study uses a repeated measures, quasi-experimental design, comprised of within-subjects and between-subjects comparisons of participants meeting BPD criteria. Participants who've attended less than four sessions were deemed “non-completer”. Persons with psychotic, bipolar, substance abuse, and head injuries were eliminated from the study. In all, this study consisted of 22 participants (19 females, and 3 males, with a mean age of 38 years old), of which 16 completed the treatment, and 6 did not. A follow up study was made within one month of the initial treatment. The results show a greater retention rate and lower drop out rate compared to other intervention methods, as well as a significant improvement in attention control. In addition, a small proportion (9 participants) of the sample showed improvements in measures of anxiety, somatoform and cognitive dissociation. The majority of the sample showed no significant change pre and post treatment, making this treatment very debatable. Suggestions of a bigger and more representative sample were made (Sachse et al., 2011). Furthermore, a second proposition in treating BPD suggests using a short-term individual therapy; Manual assisted cognitive treatment (MACT), a method created by Drs. Schmidt and Davidson in 2004 (Weinberg, Gunderson, Hennen, & Cutter Jr, 2006). MACT was...
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