Influence of Core Affect in the Differential Efficacy of a Personality Disorder Intervention Program

Abstract

The usual emotional experience of the person (affective style) is an influential factor in therapeutic assimilation. Based on a dynamic model of affect shaped dimensionally by the valence and arousal axes (core affect) that fluctuate over time according to the specific context of the individual, its relationship with different variables was investigated and the changes after a 6-month intervention in a specialized hospital unit (N = 103) were observed. The orthogonal structure of core-affect was confirmed. Emotional valence appeared to be positively related to social skills (r = .375; p < .01) and self-esteem (r = .491; p < .01) and negatively to depressive symptoms (r = -.631; p < .01), general disturbance (r = -.395; p < .01) and suicidality (r = -.490; p < .01). Emotional arousal is associated with impulsivity (r = .345; p < .01). The group of patients with an affective style characterized by negative valence and low arousal core-affect gained less therapeutic benefit compared to those with positive valence core-affect (p < .05). Throughout the treatment, valence became more positive (d = .26; IC 95%: 1.9 - 7.2; p = .001), arousal increased (d = .23; IC 95%: 0.2 - 1.7; p = .015) and variability decreased (d = -.44; IC 95%: (-2.9) - (-1.1); p = .001). Changes in the core-affect are related to therapeutic improvement. Adjusting expectations of change can reduce therapeutic frustration, which is as common as it is harmful in the treatment of severe personality disorders.

Differential Outcome of a Therapeutic Community Program for Internalizing and Externalizing Personality Disorders: A Change in Cognitive Processes Mediates Symptom Improvement

“…Data of the present paper replicate, in a remarkably larger sample, findings of a previous study (Ramos et al, 2017) that supported the significant reduction of symptoms in people with a diagnosis of severe PD who receive an specialized multiprofessional intervention articulated from the therapeutic community model for 6 months. Adherence to the program appears related to a lower intensity of antisocial and passive-aggressive traits and a greater intensity of obsessive-compulsive traits.…”

“…In a previous paper (Ramos, Sendra, Sánchez, Mena, & Rodríguez, 2017) we examined the efficacy of an intervention based on the therapeutic community model for in-patients with severe personality disorder, observing a significant symptom improvement (Cohen's d = 1.19) and a moderate decrease of PD severity (d = 0.75) in the group of adherents similar to the results achieved by other specialized programs. Typology features related to change were obtained considering the scales of the MCMI-II, non participants' individual profile.…”

Fusión Cognitiva en Trastornos de Personalidad: una Contribución a la Investigación sobre Mecanismos de Cambio

“…También nos ha faltado contar con una evaluación a más largo plazo, que hubiera permitido verificar si los cambios en FC se prolongan más allá de la intervención y la flexibilidad cognitiva fuera integrada por la persona en congruencia con otros procesos resilientes; el hallazgo de correlaciones mayores entre los constructos al final del tratamiento que al inicio del mismo podría apuntar a esta dirección. Añadamos finalmente que el diseño pre-post, al producir información acerca de resultados y no de procesos (Froján, 2011), no captura la forma del cambio, ni los moderadores ni mediadores del mismo, ni el tiempo óptimo de intervención (Laurenceau, Hayes y Feldman, 2007;Pachankis y Goldfried, 2007), aspectos dinámicos que permitirían un acceso más directo a los mecanismos subyacentes al cambio según éste vaya surgiendo (Ramos, Sendra, Sánchez y Mena, 2017).…”