Brief coping strategy enhancement for the treatment of distressing voices in the context of borderline personality disorder: A comparison with outcomes in the context of psychosis

Abstract

Background: Voice hearing in the context of Borderline Personality Disorder (BPD) has traditionally been regarded as transient and an experience that lacks legitimacy. Consequently, there are no evidence-based treatments for the voices reported by BPD patients. Contrary to the traditional view, there is a growing literature suggesting that voice hearing in the context of BPD can be an enduring and distressing experience which shares similarities with voice hearing in the context of psychosis. Given these similarities, the aim of this study was to explore whether brief Coping Strategy Enhancement developed in the context of psychosis can be used to treat distressing voice hearing in the context of BPD. Method: This was a service evaluation carried out in a specialist NHS service delivering psychological therapies for distressing voices. Patients with either a BPD (n = 46) or a psychosis diagnosis (n = 125) received four sessions of Coping Strategy Enhancement (CSE). The primary outcome was voice-related distress. The pre-post outcomes for BPD patients were explored and compared with those achieved by the psychosis patients. Results: Both the BPD and psychosis groups experienced a significant reduction in voice-related distress after CSE compared with baseline. The interaction between diagnosis group and time was small and statistically non-significant. Conclusion: These findings suggest a brief CSE intervention developed in the context of psychosis can be an effective starting point in the treatment of distressing voice hearing in the context of BPD. Such interventions have the potential to be integrated into broader BPD treatment programmes for those who hear voices.

A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review

“…Only one study examined the effectiveness of a psychological intervention for AHs in BPD. Brief Cognitive Behavioural Therapy Coping Strategy Enhancement (CBT‐CSE) is a CBT‐informed intervention for treating distressing AHs in BPD and SZ (Morrice et al, 2021). CBT‐CSE significantly reduced AH‐related distress in both BPD and SZ groups.…”

“…However, it should be noted that only one study has specifically tested the effectiveness of CSE for AHs in BPD (Morrice et al, 2021).…”

“…Secondly, BPD with AHs was also associated with heightened levels of depression and anxiety compared to SZ, highlighting the potential value of utilising emotional regulation interventions. Thus, integrating CBT-CSE with Dialectical Behaviour Therapy (DBT) might be effective in this regard (Morrice et al, 2021).…”

“…This therefore highlights the importance of clinicians carrying out comprehensive assessments of AHs of BPD in order to improve diagnostic practices and the delivery of targeted interventions. As CBT has been found to be effective in treating positive symptoms of psychosis in SZ (Bighelli et al, 2018; Hazell, 2016; Thomas et al, 2014; van der Gaag et al, 2014), it may also confer value as a treatment for AHs in BPD (Cavelti et al, 2019; Hepworth et al, 2013; Morrice et al, 2021; Slotema et al, 2017).…”

“…Specifically, incorporating CBT‐CSE into a BPD treatment plan might be clinically advantageous. CSE is a 10‐session therapy, yet it could be adapted into a brief four‐session intervention for addressing distressing AHs (Morrice et al, 2021). CSE is a functional analytic framework that identifies and improves a client's coping repertoir to manage AH experiences (Tarrier et al, 1990).…”