Construct validity of the five factor borderline inventory.

The Five Factor Borderline Inventory (FFBI) is a new self-report measure developed to assess traits of borderline personality disorder (BPD) from the perspective of the Five Factor Model of general personality. The current study sought to first replicate initial validity findings for the FFBI and then to further validate the FFBI with predispositional risk factors of the biosocial theory of BPD and with commonly associated features of BPD (e.g., depression, low self-esteem) utilizing two samples of young adults (N = 87; 85) who have engaged in nonsuicidal self-injury. The FFBI showed strong convergent and discriminant validity across two measures of the Five Factor Model and also correlated strongly with measures of impulsivity, emotion dysregulation, and BPD. The FFBI also related to two measures of early childhood emotional vulnerability and parental invalidation and measures of depression, anxiety, and self-esteem. Overall, the results provide support for the FFBI as a measure of BPD.

A preliminary investigation of the effects of the unified protocol on temperament.

Previous research has shown that two dimensions of temperament referred to as neuroticism/behavioral inhibition (N/BI) and extraversion/behavioral activation (E/BA) are key risk factors in the development and maintenance of anxiety and mood disorders (Brown & Barlow, 2009). Given such findings, these temperamental dimensions may represent promising treatment targets for individuals with emotional disorders; however, to date, few studies have investigated the effects of psychological treatments on temperamental constructs generally assumed to be "stable, inflexible, and pervasive" (American Psychiatric Association, 2000). The present study addresses this gap in the literature by examining the effects of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al., 2011), a cognitive-behavioral therapy designed to target core processes of N/BI and E/BA temperaments, in a sample of adults with principal anxiety disorders and a range of comorbid conditions. Results revealed small effects of the UP on N/BI and E/BA compared with a waitlist control group at post-treatment. Additionally, decreases in N/BI and increases in E/BA during treatment were associated with improvements in symptoms, functioning, and quality of life. Findings provide preliminary support for the notion that the UP treatment facilitates beneficial changes in dimensions of temperament.

The Impact of the Unified Protocol for Emotional Disorders on Quality of Life.

It has become increasingly clear that mental health is more than just the absence of psychopathology and that there is clinical utility in examining positive aspects of mental health. The present study examined the effects of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders on quality of life in a randomized controlled trial that included individuals with a diverse range of emotional disorders. Results indicated that the Unified Protocol produced significant increases in quality of life when examining both within-individual effect sizes and between-conditions effect sizes compared to a waitlist condition. Furthermore, results indicated that post-treatment levels of quality of life predicted levels of functional impairment independently of diagnostic severity. These results provide further evidence of the importance of examining indicators of mental health in conjunction with markers of psychopathology and provide promising evidence that the Unified Protocol may promote improved mental health in addition to treating psychopathology.

Relationships among maladaptive cognitive content, dysfunctional cognitive processes, and borderline personality features.

Previous research has demonstrated that maladaptive cognitive content, including dysfunctional attitudes and negative automatic thoughts, is associated with emotional distress. Similarly, dysfunctional cognitive processes, including thought suppression and rumination, have been shown to intensify psychological difficulties. Although maladaptive cognitive content and dysfunctional processes have been linked to borderline personality disorder (BPD), most research has been conducted with Axis I disorders. This study examined the incremental validity of dysfunctional cognitive content and processes in predicting BPD symptom severity, controlling for trait negative affect, in a sample of undergraduate students (N = 85), including many with high levels of BPD features. Although nearly all variables were significantly correlated with BPD features, final regression models suggest that rumination and thought suppression are stronger independent predictors of BPD features than automatic thoughts, dysfunctional attitudes, and trait negative affect. These results suggest the importance of targeting thought suppression and rumination in BPD.

The effect of anger rumination in the relationship between borderline personality disorder symptoms and precursors.

Previous research has identified an invalidating childhood environment and a biological predisposition for affective instability to be two precursors for the development of borderline personality disorder (BPD). In addition, rumination, particularly in response to anger, is significantly associated with symptom severity and dysregulated behavior in BPD. This study examined whether a significant relationship between childhood precursors and current BPD symptom severity could be accounted for by the tendency to engage in anger rumination in a sample of undergraduate students (N = 342), including many with high BPD features. Results showed a significant indirect effect of anger rumination in the relationship between self-reported childhood emotional vulnerability (but not invalidating childhood environment) and BPD symptom severity. This finding suggests that anger rumination could be a risk factor for BPD. These results suggest the importance of continued research on the role of anger rumination in the development and exacerbation of BPD symptoms.

Patient characteristics and variability in adherence and competence in cognitive-behavioral therapy for panic disorder.

UNLABELLED: Although associations with outcome have been inconsistent, therapist adherence and competence continues to garner attention, particularly within the context of increasing interest in the dissemination, implementation, and sustainability of evidence-based treatments. To date, research on therapist adherence and competence has focused on average levels across therapists. With a few exceptions, research has failed to address multiple sources of variability in adherence and competence, identify important factors that might account for variability, or take these sources of variability into account when examining associations with symptom change. OBJECTIVE: (a) statistically demonstrate between- and within-therapist variability in adherence and competence ratings and examine patient characteristics as predictors of this variability and (b) examine the relationship between adherence/competence and symptom change. METHOD: Randomly selected audiotaped sessions from a randomized controlled trial of cognitive-behavioral therapy for panic disorder were rated for therapist adherence and competence. Patients completed a self-report measure of panic symptom severity prior to each session and the Inventory of Interpersonal Problems-Personality Disorder Scale prior to the start of treatment. RESULTS: Significant between- and within-therapist variability in adherence and competence were observed. Adherence and competence deteriorated significantly over the course of treatment. Higher patient interpersonal aggression was associated with decrements in both adherence and competence. Neither adherence nor competence predicted subsequent panic severity. CONCLUSIONS: Variability and "drift" in adherence and competence can be observed in controlled trials. Training and implementation efforts should involve continued consultation over multiple cases in order to account for relevant patient factors and promote sustainability across sessions and patients.

Readiness to change as a moderator of outcome in transdiagnostic treatment.

Initial symptom severity is a client characteristic associated with psychotherapy outcome, although this relationship is not well-understood. Readiness to change is a factor that may influence this relationship. This study tested readiness as a moderator of the relationship between initial severity and symptom change. Data were derived from an RCT examining the efficacy of a transdiagnostic CBT treatment. Readiness was assessed with the URICA, and symptom and functioning outcomes were assessed. Multiple regression models indicated that severity was associated with less overall change, yet readiness moderated this relationship. At higher levels of readiness, the effect of initial severity on outcome was essentially reversed; for clients with higher initial readiness, higher levels of severity were associated with greater change.