Meaningful Ways of Understanding and Measuring Change for People with Borderline Personality Disorder: A Thematic Analysis

McCusker, Louise; Turner, Marie-Louise; Pike, Georgina; Startup, Helen

doi:10.1017/s1352465818000036

Cited by 5 publications

(9 citation statements)

References 24 publications

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“…Thus, the findings of this study highlight the equal importance of concurrently addressing both core emotional issues within therapy, as well as facilitating social connection and support when considering treatment and recovery options for people with BPD and co-occurring impulse disorders. These findings concur with recent qualitative explorations of BPD recovery (Donald et al , 2017a, 2017b; Katsakou and Pistrang, 2017; Castillo et al , 2013; Gillard et al , 2015; Lariviere et al , 2015; McCusker et al , 2018) as well as with broader attempts to conceptualise the recovery trajectories of people with SUDs and mental health difficulties within one unifying framework. For instance, the US Department of Substance Abuse and Mental Health Services (SAMHSA, 2006) has published a working definition of recovery that encompasses ten guiding principles, all of which are arguably reflected within the themes presented in the current study: hope (hope and purpose), self-determination (agency and autonomy), relationships, social and peer support, respect (societal acceptance and fostering self-acceptance: addressing stigma), taking a holistic approach (self-care, occupation, finances, housing, etc.)…”

Section: Discussionsupporting

confidence: 88%

Borderline personality disorder, substance abuse and disordered eating: perceptions of treatment and recovery within community mental health

Mooney,

Crafti,

Broadbear

2023

JMHTEP

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Purpose Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery. Design/methodology/approach In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles. Findings As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders. Practical implications This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes. Originality/value The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

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Section: Discussionsupporting

confidence: 88%

Borderline personality disorder, substance abuse and disordered eating: perceptions of treatment and recovery within community mental health

Mooney,

Crafti,

Broadbear

2023

JMHTEP

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“…For further refinement of treatment for personality disorder, investigation of factors promoting or challenging the therapeutic process are central. In this regard, user perspectives and qualitative exploration of first-hand accounts are valuable resources (Little et al, 2018; McCusker, Turner, Pike, & Startup, 2018; Montgomery & Donnelly, 2014). It has been suggested that the introductory, psychoeducational group may contribute to the low drop-out rates reported in MBT (Kvarstein et al, 2014).…”

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confidence: 99%

“Yes, there is actually hope!”—A qualitative investigation of how patients experience mentalization-based psychoeducation tailored for borderline personality disorder.

Ditlefsen¹,

Nissen‐Lie²,

Andenæs³

et al. 2021

Journal of Psychotherapy Integration

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Common factors, such as the working alliance, positive expectations, and psychoeducation have been robustly related to outcome in studies of psychotherapy. As a multicomponent treatment for borderline personality disorder (BPD), Mentalizationbased treatment (MBT) includes introductory group-based psychoeducation on core features of personality functioning, BPD, the treatment program and disorder-related personal management. Generally, few studies have investigated patients' views on how psychoeducation works. This study aimed to explore their experience of the group-based psychoeducation. Twelve patients who had attended the introductory group-based psychoeducation in MBT participated. Qualitative interviews were analyzed using Interpretative Phenomenological Analysis. MBT psychoeducation was found helpful in itself and in the further treatment process. Identified experiences related to the group (feeling less ashamed, learning from others, feeling different from others), acquisition of "tools" for better personal management (the psychoeducational content; putting new knowledge into practice), preparation for longer term therapy (therapy became more trustworthy, easier to understand, felt more effective), and demanding aspects (problems with attendance or concentration). This qualitative study is the first to present patients' own experiences of psychoeducation as part of MBT and suggests that psychoeducation is a powerful and facilitating intervention. Careful patient selection may further optimize its potential.

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“…Only 13% of the participants who completed treatment could be considered recovered in line with IAPT criteria. Still, the aim of STEPPS-EI is not primarily to address symptoms of depression or anxiety but rather emotional intensity, hence it would be misguided to evaluate the feasibility of STEPPS-EI based solely on these recovery rates (McCusker et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Subthreshold personality disorder: how feasible is treatment in primary care?

Barber

Apps

Strauss

et al. 2021

tCBT

Self Cite

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Individuals with subthreshold borderline personality disorder (BPD) are commonly encountered in primary care settings, yet the psychological treatments they receive are rarely tailored to their needs. In an effort to capture and treat this group of individuals in a targeted and meaningful way, some primary care settings offer Systems Training for Emotional Predictability and Problem Solving – Emotional Intensity (STEPPS-EI). This evaluation sought to assess the feasibility of STEPPS-EI within NHS primary care services. Employing an uncontrolled design, the evaluation examined recruitment, retention, effectiveness and group appraisal. Findings supported three out of four evaluation objectives for feasibility: uptake of the group was high at 74%, the group was well received by the group and significantly effective at reducing symptoms of BPD, depression and anxiety. However, retention rates were low, with only 43% classed as ‘completers’ of the programme. The results indicate preliminary evidence for STEPPS-EI as a potentially feasible intervention with possible modification to enhance retention and avenues for further study. Key learning aims After reading this paper, the reader will be aware of: (1) Recent developments in the classification and diagnosis of personality disorder leading to the conceptualisation of subthreshold presentations. (2) The feasibility of conducting a primary care intervention for individuals with emotional intensity difficulties. (3) The preliminary beneficial outcomes of utilising a primary care intervention for individuals with emotional intensity difficulties. (4) Potential issues for participants and providers of primary care programmes with future direction for improvement and implementation.

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Meaningful Ways of Understanding and Measuring Change for People with Borderline Personality Disorder: A Thematic Analysis

Abstract: This investigation highlights the complex nature of measuring change in people who have received a BPD diagnosis. Further research is needed to develop meaningful ways of measuring change according to the needs and priorities of people with BPD.

Cited by 5 publications

References 24 publications

Borderline personality disorder, substance abuse and disordered eating: perceptions of treatment and recovery within community mental health

Borderline personality disorder, substance abuse and disordered eating: perceptions of treatment and recovery within community mental health

“Yes, there is actually hope!”—A qualitative investigation of how patients experience mentalization-based psychoeducation tailored for borderline personality disorder.

Subthreshold personality disorder: how feasible is treatment in primary care?

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