Evaluation of a skills-based peer-led art therapy online-group for people with emotion dysregulation

Abstract

Objective We developed and piloted a novel art-based online skills program led by a peer mental health professional with lived experience of complex mental health, including Borderline Personality Disorder (BPD). Key challenges of living with BPD and emotion dysregulation were addressed through artmaking informed by a dialectical framework and skills, to evaluate acceptability and efficacy. Method A structured, manualised 2-hour weekly arts-based skills program was piloted for people with BPD over 18 weeks. Evaluation included both quantitative and qualitative measures at commencement and completion. Results Thirty-eight participants enrolled in the program (89.5% identified she/her pronouns, average age 33.6 years), and 31 completed (82% retention). Multilevel modelling analysis of the primary outcome variable Difficulties in Emotion Regulation Scale (DERS) demonstrated a large improvement over time (effect size Cohen’s d = 1.77). Qualitative thematic analysis found participants had improved capacity to regulate emotions and tolerate distress, improved connection with others, enhanced understanding of the self, and higher hope for living well. We found that artmaking facilitated processes and helped the expression of difficult emotions, symbolise challenging relationships, and facilitate greater self-understanding. Participants reported high levels of satisfaction, and 77.4% reported that the program had increased wellbeing. Conclusion This novel artmaking program for emotion dysregulation and BPD was acceptable and potentially effective. Peer facilitation using arts-based skills is a modality of therapy for further investigation.

Experiences of a peer group for people diagnosed with borderline personality disorder: A qualitative interview study

“…The themes identified in the feedback from peer group participants align with the extant literature regarding benefits of peer support for people with serious mental illness, specifically social support, empowerment, increased self‐efficacy, and promotion of self‐management (Repper & Carter, 2011), and demonstrated that this is also achievable for people diagnosed with BPD in a group setting. The findings parallel qualitative feedback in the evaluation of a skills‐based peer‐led art group for people with difficulties in emotional regulation and BPD, in which participants reported benefits in being able to be vulnerable and connected with others, with the role of peer facilitation bringing authenticity to the experience (Jewell et al, 2022). Our findings emphasized how a peer‐led group helped people to feel safe and overcome some of the barriers that may be perceived in clinical settings, given consumers may be less concerned about power dynamics when interacting with peer workers (Barr et al, 2022).…”

“…Similar to Jewell et al (2022), integrating creative activities into the group structure was important and may increase treatment engagement for people who find traditional therapeutic environments overwhelming or a poor fit to their needs. The literature suggests that while some people with borderline symptoms go on to achieve personal recovery (stable functioning with good interpersonal relationships, self-worth, and vocational functioning), those that do not improve over time may benefit from programmes that specifically focus on activities of daily living and interpersonal relationships (Grenyer et al, 2022).…”

“…While a number of psychological approaches have been found to be effective in treating the symptoms of BPD (Cristea et al, 2017;Storebø et al, 2020), Australian studies exploring the experiences of carers and consumers have identified treatment barriers such as long waiting lists, outof-pocket expenses, and a lack of access to services in rural and remote regions (Lawn & McMahon, 2015). Alternative models such as stepped care (Choi-Kain et al, 2016;Grenyer, 2014;Laporte et al, 2018) and coproduced interventions (Jewell et al, 2022) may increase treatment engagement and accessibility as well as address important domains of personal recovery, that is, "to love and work" (Grenyer et al, 2022). Carrotte et al (2019) asked consumers with a diagnosis of BPD about the perceived benefits and challenges associated with the treatments available to them.…”

“…Outcomes from the 11‐week intervention were promising with participants ( n = 68) demonstrating significant improvements in knowledge about personality disorders, reduced borderline symptom severity, and improvements in work and social functioning (Rocca et al, 2021). Jewell et al (2022) explored the effectiveness of an 18‐week online peer‐led art therapy group which included skills based upon dialectical principles and topics on self‐stigma, invalidation, and anger. Participants who completed the programme ( n = 31) reported a significant reduction in emotional dysregulation.…”

Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience

“…Lived experience perspectives have been important in previous studies to broaden the concept of ‘recovery’ and the importance of ‘love and work’ goals for individuals with BPD (Grenyer et al, 2022; Ng et al, 2016; Ng, Carter, et al, 2019). Similarly, lived experience has also been meaningfully incorporated into health service delivery, either through encouraging service redesign (Barr, Jewell, et al, 2020) or through peer‐led interventions (Barr, Townsend, & Grenyer, 2020; Jewell et al, 2022). However, in terms of receiving a diagnosis of BPD, lived experience perspectives are somewhat scant.…”