Higher Executive Control and Visual Memory Performance Predict Treatment Completion in Borderline Personality Disorder

Abstract

Background: Non-completion of a prescribed course of treatment occurs in 20–60% of individuals diagnosed with borderline personality disorder (BPD). While symptom severity, personality traits and environmental factors have been implicated as predictors of treatment non-completion (TNC), there have been no studies of neuropsychological predictors in this population. Methods: From a randomized controlled trial, a subsample of 31, unmedicated outpatients diagnosed with BPD with recent self-injurious behavior was assessed on 5 neuropsychological domains. Patients were also assessed for general IQ, demographic and other salient clinical variables. Patients were randomized to one of four treatment conditions, which lasted up to 1 year. Number of weeks in treatment (WIT) up to 1 year was utilized as the index of TNC. Results: Thirty-three percent of the subsample (n = 12) did not complete 1 year of treatment. However, more WIT were predicted by better baseline executive control (Trails B; p < 0.01) and visual memory performance (Benton visual retention; p < 0.001); other neuropsychological domains did not predict WIT. Conclusion: In the treatment of outpatients with BPD, better executive control and visual memory performance predict more WIT. Assessing and addressing these neurocognitive factors in treatment may reduce TNC in this high-risk population.

Effectiveness and Cost-Effectiveness of Dialectical Behaviour Therapy for Self-Harming Patients with Personality Disorder: A Pragmatic Randomised Controlled Trial

“…A systematic review of treatment attrition in BPD patients undergoing psychotherapy [35] highlighted factors such as poor therapeutic alliance, low motivation to change and high impulsivity as predictors of therapy attrition. Recent neuropsychological research has also demonstrated that lower executive control and visual memory performance predict dropout [37]. Measures of such factors could be used for improving completion rates in DBT as well as in other psychotherapies which have been demonstrated to improve outcomes in the BPD population, such as transference-focused therapy [38], schema-focused therapy [39], STEPPS [40], mentalisation-based therapy [41], and narrative exposure therapy [42].…”

Emotions and Memory in Borderline Personality Disorder

“…Also, predictors of psychotherapy success could be depicted. Fertuck et al [155], for example, found that better baseline visual memory performance as well as better executive functioning predicted short durations of treatment in dialectical behavior therapy, supportive therapy, or drug treatment. These studies already point to the fact that the feasibility of the proposed studies is a difficult issue, as even in these studies treatments were intermixed.…”

Analysis of Participant Withdrawal in Huntington Disease Clinical Trials

“…Previous studies have shown that strategies to improve protocol adherence and participant retention may include enrolling people at early disease stages such as in amyotrophic lateral sclerosis clinical trials [10]. In line with this hypothesis, higher executive control and visual memory performance was shown to be associated with treatment completion in borderline personality disorder clinical trials [11]. On the other hand, restricting eligibility criteria may have implications on recruitment rate, which both add to the duration and cost of the trial.…”