Difficulties in emotional regulation mediates the impact of burden on quality of life and mental health in a sample of family members of people diagnosed with Borderline Personality Disorder.

Background: Although it has been suggested that family members of persons suffering from Borderline Personality Disorder (BPD) endure high levels of burden, however, the process and the impact of this burden in their lives, and specifically the relation between the burden and emotional regulation has not been broadly investigated among this population. The main objective of this study is to examine the impact of burden on quality of life and depression, anxiety and stress, as mediated by difficulties in emotional regulation in family members of persons diagnosed with BPD. Method: Participants were 167 family members of persons diagnosed with BPD. The Burden Assessment Scale, Difficulties in Emotion Regulation Scale, Multicultural Quality of Life Index, and Depression Anxiety Stress Scale-21 were filled out. Mediation analysis was conducted using the Maximum Likelihood estimator, bootstrap method and listwise deletion for missing data. Results: Burden showed a significant, negative effect on quality of life and positive on depression, anxiety and stress. Difficulties in emotion regulation significantly mediated these relations. After accounting for the mediating role of difficulties in emotion regulation, burden still had an impact on quality of life, depression, anxiety and stress. Women showed a higher level in both burden and stress than men. The caregivers with secondary and higher studies showed higher levels in burden than those with no studies. Not significant differences in burden, emotion regulation, depression, anxiety and stress were found related to marital status. Conclusion: Difficulties in emotion regulation mediate the relations between burden and quality of life, depression, anxiety, and stress. Family members could engage in group interventions designed specifically for family members of people with BPD, oriented toward understanding the disorder or learning skills.

Spanish adaptation of the Burden Assessment Scale in family caregivers of people diagnosed with borderline personality disorder.

BACKGROUND: Caregiving is a strong source of stress and leads the family caregiver to experience the burden of being responsible for the care of a severely mentally ill family member. The Burden Assessment Scale (BAS) assesses burden in family caregivers. This study aimed to analyze the psychometric properties of the BAS in a sample of family caregivers of people diagnosed with Borderline Personality Disorder (BPD). METHODS: Participants were 233 Spanish family caregivers (157 women and 76 men aged between 16-76 years old, M = 54.44, SD = 10.09) of people diagnosed with BPD. The BAS, the Multicultural Quality of Life Index, and the Depression Anxiety Stress Scale-21 were used. RESULTS: An exploratory analysis resulted in a three-factor 16-item model (Disrupted Activities; Personal and Social Dysfunction; Worry, Guilt, and Being Overwhelmed) with an excellent fit (χ2(101) = 56.873, p = 1.000, CFI = 1.000, TLI = 1.000, RMSEA = .000, SRMR = .060), good internal consistency (ω = .93), a negative correlation with quality of life, and a positive correlation with anxiety, depression, and stress. CONCLUSION: The model obtained for the BAS is a valid, reliable, and useful tool for assessing burden in family caregivers of relatives diagnosed with BPD.

Multicultural Quality of Life Index in Relatives of People With Borderline Personality Disorder.

Purpose: The aim of the present study was to confirm the original factor structure of the Multicultural Quality of Life Index (MQLI) and analyze its psychometric properties in a sample of caregivers of people with borderline personality disorder (BPD). Methods: The MQLI was administered to 233 relatives of people with BPD. Participants completed the MQLI, the Depression, Anxiety and Stress Scale (DASS-21), and the Connor-Davidson Resilience Scale (CD-RISC). Results: Factor analysis of the relatives indicated that the MQLI generated a one-factor solution. The MQLI showed good internal consistency, ϖ = 0.91 [95% CI (0.90, 0.93)] and correlated significantly and positively with the CD-RISC (r s = 0.576) and negatively with the DASS-21 (r s = -0.583). Conclusion: Consistent with other studies, the MQLI demonstrated feasibility, strong internal consistency, and good convergent and discriminant validity, which means it is a psychometrically robust measure for the assessment of quality of life in relatives of people with BPD. Along with other validation studies, this measure will be a useful tool for assessing quality of life in relatives of people with mental disorders.

Mindfulness Component in a Dialectical Behavioural Therapy Group Intervention for Family Members of Borderline Personality Disorder Patients.

BACKGROUND: Family members of people with borderline personality disorder (BPD) are seriously affected by the disease and it is common for them to ask for professional help. The main objective of this study is to assess, in an open clinical trial, a treatment protocol based on Dialectical Behaviour Therapy (DBT) strategies for relatives of individuals with BPD, compared to the same protocol plus a mindfulness component (DBT-M). METHOD: The interventions were conducted in a sample of 108 relatives of 83 patients diagnosed with BPD from a Specialized Unit for Personality Disorders. Relatives and patients completed the assessment protocol before and after the intervention. RESULTS: Significant improvements in almost all the relevant variables tested were observed after the treatment in both the relatives and the patients. However, there were only statistically significant differences between the groups in the negative attitude towards the illness, where relatives in the DBT-M condition showed greater improvement than those in the DBT condition. CONCLUSIONS: The results indicate that the intervention helps both patients and relatives to improve on key issues. It is essential to consider and offer support to the families of people with severe psychological disorders.

Psychological assessment of parents of people diagnosed with borderline personality disorder and comparison with parents of people without psychological disorders.

Background: To date, several evidence-based interventions have been created to help relatives of people with Borderline Personality Disorder (BPD), but few studies have analyzed the clinical situation of the family members. The aim of this study was twofold: (1) to explore the clinical symptomatology in a sample of parents of people diagnosed with BPD and compare them with a sample of a sample of people without a relative with a personality disorder, (2) to explore whether the parents of people diagnosed with BPD have psychopathology related to personality disorders (PD) or meet the diagnostic criteria for PD. Method: Participants were 42 (39.6%) fathers and 64 (60.4%) were mothers and mothers (n = XX, −%) of people diagnosed with BPD, who were selected from a specialized PD unit for treatment. The sample of people without a relative with a PD was obtained from social network announcements. To test for differences between the two groups, Student's t tests were performed for quantitative variables, and Chi-square tests were performed for categorical variables. Cohen's d was calculated as a measure of the effect size. Results: Parents of people with BPD showed greater depressive and anxious symptomatology, higher levels of expressed emotion, and worse quality of life than the sample of people without a relative with a personality disorder. In addition, a high percentage of the parents of people diagnosed with BPD (50%) met the diagnostic criteria for different PD. Conclusion: Parents of people diagnosed with BPD may need psychological help in various aspects. Therapists are therefore advised to bear in mind the importance of carrying out a psychological assessment of family members and, if necessary, to offer psychological intervention. It is crucial to invite the family to be part of the treatment, since they can be part of the solution.Clinical Trial registration: ClinicalTrials.gov ID, NCT04160871 (registered November 15, 2019).

Mindfulness Component in a Dialectical Behavioural Therapy Group Intervention for Family Members of Borderline Personality Disorder Patients / Mindfulness en una Intervención Grupal de Terapia Dialéctica Conductual para Familiares de Pacientes con Trastorno Límite de la Personalidad

Background: Family members of people with borderline personality disorder (BPD) are seriously affected by the disease and it is common for them to ask for professional help. The main objective of this study is to assess, in an open clinical trial, a treatment protocol based on Dialectical Behaviour Therapy (DBT) strategies for relatives of individuals with BPD, compared to the same protocol plus a mindfulness component (DBT-M). Method: The interventions were conducted in a sample of 108 relatives of 83 patients diagnosed with BPD from a Specialized Unit for Personality Disorders. Relatives and patients completed the assessment protocol before and after the intervention. Results: Significant improvements in almost all the relevant variables tested were observed after the treatment in both the relatives and the patients. However, there were only statistically significant differences between the groups in the negative attitude towards the illness, where relatives in the DBT-M condition showed greater improvement than those in the DBT condition. Conclusions: The results indicate that the intervention helps both patients and relatives to improve on key issues. It is essential to consider and offer support to the families of people with severe psychological disorders.(AU)

Antecedentes: Los familiares de las personas con trastorno límite de la personalidad (TLP) son unos de los grandes afectados por el trastorno, y resulta frecuente que soliciten ayuda profesional. El objetivo estudio es evaluar un protocolo de tratamiento basado en estrategias de Terapia Dialéctica Conductual (DBT) para familiares de personas con TLP, en comparación con el mismo protocolo más un componente de mindfulness (DBT-M). Método: Las intervenciones se realizaron en una Unidad Especializada en Trastornos de la Personalidad, en una muestra 108 familiares de 83 pacientes diagnosticados de TLP. Familiares y pacientes completaron el protocolo de evaluación antes y después de la intervención. Resultados: Se observan mejoras significativas tanto en los familiares como en los pacientes tras el tratamiento, en casi todas las variables relevantes. Sin embargo, sólo hubo diferencias estadísticamente significativas entre las dos condiciones en la actitud negativa hacia la enfermedad, donde los familiares en la condición DBT-M mostraron una mejoría mayor que los de la condición DBT. Conclusiones: Los resultados indican que la intervención ayuda, tanto a los pacientes como a los familiares, a mejorar en aspectos clave. Resulta fundamental tener en cuenta y ofrecer apoyo a los familiares de personas con trastornos psicológicos graves.(AU)

Resilience as a predictor of quality of life in participants with borderline personality disorder before and after treatment.

BACKGROUND: Studies have suggested that psychotherapy improves the Quality of Life (QoL) of participants with Borderline Personality Disorder (BPD). However, there are no studies on the differential efficacy of treatments on the QoL of participants with BPD. Moreover, the relationship between QoL and resilience has rarely been studied in participants with BPD. OBJECTIVES: a) to examine whether people with BPD have worse QoL than the non-clinical population; b) to examine whether there are statistically significant differences between Dialectical Behavioural Therapy (DBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS), or Cognitive Behavioural Therapy-Treatment at Usual (CBT-TAU) in the improvement of QoL; c) to examine whether participants show clinically significant improvements in QoL after treatment; d) to analyse whether resilience is associated with QoL before and after the BPD treatment; e) to analyse whether resilience is a predictor of QoL at pre-treatment and posttreatment. METHOD: The sample comprised 403 participants (n = 202 participants diagnosed with BPD and n = 201 non-clinical). Participants filled out the Quality of Life Index, Resilience Scale, and Beck Depression Inventory. The clinical participants received one of these possible treatments, DBT, STEPPS, or CBT-TAU. MANOVA and regression analyses were performed. RESULTS: a) participants diagnosed with BPD had statistically significant lower resilience than the non-clinical population; b) all three forms of psychotherapy statistically improved QoL, but there were no statistically significant differences between DBT, STEPPS, and CBT-TAU in the improvement of QoL; c) participants did not show clinically significant improvements in QoL after treatment; d) resilience was associated with QoL before and after treatment; and e) resilience was a predictor of QoL before and after treatment. CONCLUSION: It is necessary to assess QoL and Resilience in studies on psychotherapy with BPD patients.

Un programa de entrenamiento para familiares de pacientes con trastorno límite de la personalidad basado en la terapia dialéctica comportamental / A training program for family members of patients with borderline personality disorder based on dialectical behavior therapy

Los familiares de pacientes con trastorno límite de la personalidad (TLP) experimentan ansiedad y depresión, y están inmersos en un clima familiar disfuncional. Aunque existen tratamientos eficaces para el TLP, se ha prestado menos atención a los familiares. El objetivo de este trabajo fue adaptar para familiares el entrenamiento grupal en habilidades de la terapia dialéctica comportamental, en 14 sesiones. La muestra estuvo formada por 12 familiares: 50% madres, 41,7% padres y 8,3% parejas. Se evaluaron los niveles de depresión (BDI-II), ansiedad (OASIS) y emoción expresada (LEE-S) antes y después de la intervención. Los resultados indican que tras la intervención se produce una mejoría estadística y clínica significativa en depresión; clínica en ansiedad, hostilidad, tolerancia a la frustración y emoción expresada; y estadística de la actitud negativa hacia la enfermedad. La intrusión aumenta tanto estadística como clínicamente, sin embargo, sus niveles son similares a los de la población general. Resulta imprescindible seguir investigando sobre la eficacia de las intervenciones para familiares (AU)

Family members of patients with borderline personality disorder (BPD) experience suffering, anxiety, and depression, and are involved in a dysfunctional family atmosphere. Although effective treatments for patients with BPD have been developed, family members have received less attention. The aim of this paper was to adapt the dialectical behaviour therapy skills training group for family members in 14 sessions. The sample comprised 12 family members: 50% mothers, 41.7% fathers, and 8.3% partners. The levels of depression (BDI-II), anxiety (OASIS) and expressed emotion (LEE-S) were measured before and after the intervention. The results show a statistical and clinical improvement in depression, and a clinically significant improvement in anxiety, hostility, lack of tolerance and expressed emotion after the intervention. Negative attitude toward illness presents a statistical improvement. Furthermore, intrusion increases both statistically and clinically. However, the levels of intrusion are equal to those in the general population. Further research into the effectiveness of family interventions is essential (AU)

Healthy Teens @ School: Evaluating and disseminating transdiagnostic preventive interventions for eating disorders and obesity for adolescents in school settings.

BACKGROUND: The worldwide prevalence of overweight and obesity is at alarming levels. Nearly one in three children in Europe is overweight or obese. Disordered eating and body image concerns are equally widespread and increase risk for more chronic and severe weight-related problems. Research has shown that online interventions that address both healthy weight regulation and body image can reduce risk for eating disorders and obesity simultaneously and are feasible to implement in school settings. To date, evaluation and dissemination of such programs in Europe is scant. METHODS: The Healthy Teens @ School study is a multi-country cluster-randomized controlled trial (RCT) comparing the effectiveness of an unguided, online, multi-level intervention for promoting a healthy lifestyle and reducing problematic eating behavior, eating disorder and obesity risk among students aged 14 to 19 years with control condition. As part of the Horizon 2020 funded project ICare (GA No. 634757) the trial is conducted in Austria and Spain. Cluster randomization by school is used. The intervention is an adapted version of an evidence-based program developed in the USA (StayingFit). Participants of the intervention group are assigned to one of two possible program tracks based on the results of the initial online-assessment: Overweight adolescents are assigned to the "Weight Management" track emphasizing balanced eating and exercise for weight maintenance, and all other individuals are assigned to the "Healthy Habits" track which aims at promoting healthy habits related to e.g., nutrition, physical activity, sleep. The participants of both tracks work on ten modules (one 20-30 min module per week) during school hours and/or at home. Assessments are conducted at pre- and post-intervention, and at 6- and 12-months after baseline assessment. The primary outcome is intuitive eating, secondary outcomes are eating disorder symptomatology, body image concerns, body mass index, food intake, physical activity, self-esteem, stress coping, depression, and anxiety. Following the initial assessment, individuals in the control group do not have access to the prevention program but continue as normal and are only prompted to the assessments at all time points. At the end of the 12-month study they will get access to the program. DISCUSSION: The results from this study will add to the understanding of how to address eating and weight related problems in adolescents and will shed light on the feasibility of implementing online prevention programs in school routine in Austria and Spain. As part of the larger ICare project this RCT will determine how an adapted version of StayingFit is disseminated within Europe.

Angry thoughts in Spanish drivers and their relationship with crash-related events. The mediation effect of aggressive and risky driving.

Several studies have related aggressive and risky driving behaviours to accidents. However, the cognitive processes associated with driving aggression have received very little attention in the scientific literature. With the aim of shedding light on this topic, the present research was carried out on a sample of 414 participants in order to validate the Driver's Angry Thoughts Questionnaire (DATQ) with a sample of Spanish drivers and to test the hypothesis of the mediation effect of aggressive and risky driving on the relationship between drivers' angry thoughts and crash-related events. The results showed a good fit with the five-factor model of the questionnaire (Judgmental and Disbelieving Thinking, Pejorative Labelling and Verbally Aggressive Thinking, Revenge and Retaliatory Thinking, Physically Aggressive Thinking, and Coping Self-Instruction). Moreover, slight gender differences were observed in drivers' angry thoughts, with women scoring higher than men (η2=0.03). However, younger drivers had higher scores than older drivers in general (η2=0.06). Finally, several mediation effects of aggressive driving and risky driving on the relationship between aggressive thinking and the crash-related events were found. Implications of the results for research in traffic psychology and clinical assessment of aggressive drivers as well as limitations of the study are discussed.

Historia de la investigación española en psicología vista a través de las revistas científicas recogidas en la Web of Science durante el periodo 2003-2012 / History of Spanish research in psychology seen through the scientific journals collected in the Web of Science during the period 2003-2012

Resumen La abundancia y nivel de las publicaciones científicas constituye un indicador de la capacidad, trayectoria y calidad científica de un país, área temática o grupo de investigación. El grado de visibilidad internacional de una revista es un importante indicador sobre su calidad y cada vez es más considerado por las agencias de evaluación de los méritos científicos. Este estudio ofrece un análisis de la evolución de la actividad española en psicología, vista a través de su producción científica en las revistas de psicología recogidas en las bases de datos JCR del SSCI (Social Sciences Citation Index) y del SCI (Science Citation Index) durante 2003-2012. Los resultados indican un crecimiento en la producción científica española en este periodo y un crecimiento en el número de revistas españolas y latinoamericanas en las bases de datos JCR (SCI y SSCI), lo que es un indicador del esfuerzo que están realizando los editores de las revistas de estos países en cuidar los aspectos formales de las publicaciones y aumentar su calidad, obteniendo una mayor proyección internacional y un aumento de su presencia en bases de datos internacionales. El comportamiento de los investigadores en psicología, es diferente, dependiendo de las áreas temáticas. Como conclusión, destacar que a lo largo del periodo estudiado se observa un aumento en el número de revistas utilizadas para publicar los trabajos de psicología. Durante el quinquenio 2008-2012 las revistas más utilizadas por los investigadores españoles fueron las editadas en España, Francia, Inglaterra, los Estados Unidos y Colombia.

Abstract The level and great number of scientific publications is an indicator of the ability, experience and scientific quality of a country, subject area or research group. Nowadays, the importance of a journal is given in many cases by their visibility degree. The international visibility degree is an important indicator of the quality of a magazine that is increasingly considered by most evaluating scientific merits agencies. This study analysis the evolution of Spanish psychology activity, as seen through its scientific production in psychology journals listed in the JCR database of SSCI (Social Sciences Citation Index) and SCI (Science Citation Index) during the years 2003-2012. The results indicate a growth in the Spanish scientific production during the period studied and a growth in the number of Spanish and Latin American journals in the JCR data bases (SCI and SSCI), which is an indicator of the effort made by the journal editors of these countries in the formal aspects of their publications and making the necessary changes to improve their quality. It is also observed that the behavior of psychology researchers is different depending on the subject field in which they work. In conclusion, it is outstanding that throughout the study period the most commonly number of magazines that used to publish psychology articles increased. Being the most extended, during the five years period between 2008-2012, the ones published in Spain, France, England, United States and Colombia.