ABSTRACT
BACKGROUND: Patients with borderline personality disorder (BPD) experience significant affect regulation difficulties that cause serious consequences in their work, emotional, and social environments. This dysfunctional pattern also produces great suffering and a heavy burden on their relatives. Fortunately, some studies show that treatment of relatives of people with BPD begins to be important in the patients' recovery and in improving family dynamics. One of the treatments that has obtained the most empirical support is Family connections (FC). This 12-session program is an adaptation of different Dialectical Behavior Therapy strategies. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre-post treatment and follow-up assessments. The results of these studies and subsequent replications showed an improvement in family attitudes and caregiver burnout. Our research team adapted FC for delivery in the Spanish population. We intend to test the efficacy of this program versus a treatment as usual condition. Moreover, we aim to test the efficacy of this program and study its effectiveness (in terms of participants' acceptance). This paper presents the study protocol. METHODS: The study is a randomized controlled trial. The participants will be recruited in a Personality Disorders Unit and randomly assigned to one of two treatment conditions: Family Connections group (FC) or Treatment As Usual (TAU). Primary outcome measures will be the BAS and FAD-GFS. Secondary outcomes will include DASS-21, FES, GS, and QLI. Participants' treatment acceptance and degree of satisfaction will also be measured. Participants will be assessed at pre-, post-treatment, and 6-month follow-up. Intention to treat and per protocol analyses will be performed. DISCUSSION: This is the first study on FC for relatives of people with borderline personality disorder (BPD) compared to an active condition (TAU), and this is the first time relatives' and patients' data will be analyzed. In addition, it is the first study to test the efficacy of the program in Spain. This intervention could contribute to improving the efficiency and effectiveness of current treatment programs for relatives of people with BPD, help to decrease burden, and improve the family connection. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04160871. Registered November 15th 2019.
Subject(s)
Borderline Personality Disorder , Dialectical Behavior Therapy , Family Relations , Borderline Personality Disorder/therapy , Humans , Personality Disorders , Spain , Treatment OutcomeABSTRACT
El trastorno límite de la personalidad (TLP) constituye uno de los cuadros psicopatológicos más complejos y difíciles de abordar. Uno de los programas de tratamiento que ha demostrado eficacia empírica es la Terapia dialéctico-comportamental (Dialectical Behavior Therapy, DBT). El TLP aparece a menudo como condición comórbida en los trastornos de la conducta alimentaria (TCA) y suele ser indicativo de un peor pronóstico. El objetivo del presente trabajo es ofrecer datos de la eficacia preliminar de la DBT con la presentación de dos casos diagnosticados de TLP y bulimia nerviosa tras ser tratados durante un año. Los resultados de este estudio indican una disminución de las conductas desadaptativas de regulación del afecto, abuso de tóxicos, conductas autolesivas, sintomatología depresiva (BDI-II) y comer emocional (EES), número de ingresos hospitalarios, puntuaciones menores en la escala de interferencia y gravedad valorada por el clínico y un aumento en la escala de evaluación de la actividad global (Eje V, DSM-IV-TR) de las pacientes. Estos datos preliminares confirman la posible eficacia de la DBT para tratar pacientes con TLP grave y TCA (AU)
The borderline personality disorder (BPD) is very complex psychopathologically and one of the psychological problems most difficult to treat. One of the treatment programs that has demonstrated to be effective empirically is Dialectical Behavior Therapy (DBT). BPD is often encountered as a comorbid condition in eating disorders what is usually a factor of worse prognosis. The aim of the present study is to offer preliminary evidence of the efficacy of DBT in two cases with a diagnosis of BPD and bulimia nervosa after one year of treatment. The results of this study showed decreases in desadaptative behaviours to regulate affect, substance abuse, self-mutilation behaviors, depressive symptoms (BDI-II), emotional eating (EES), number of hospitalizations, lower scores in global impairment and severity rated by the clinician, and higher scores in global assessment of functioning (Axis V, DSM-IV-TR). These preliminary data showed the possible efficacy of DBT to treat patients with severe BPD and eating disorders
