Predictors of Treatment Response to an Adjunctive Emotion Regulation Group Therapy for Deliberate Self-Harm Among Women With Borderline Personality Disorder
Predictors of Treatment Response to an Adjunctive Emotion Regulation Group Therapy for Deliberate Self-Harm Among Women With Borderline Personality Disorder
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DOI：
10.1037/per0000062
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发表时间：
2014-01-01
影响因子：
2.8
通讯作者：
Tull, Matthew T.
中科院分区：
文献类型：
--
作者：
Gratz, Kim L.;Dixon-Gordon, Katherine L.;Tull, Matthew T.
尽管有证据表明，边缘型人格障碍（BPD）中的故意自残（DSH）的几种治疗方法有效，但对这些治疗反应的预测因素仍然未知。本研究调查了BPD女性患者对连续性情绪调节团体疗法（ERGT）治疗DSH反应的基线人口统计学、临床和诊断预测因素。最近的一项随机对照试验提供了这种ERGT疗效的证据（相对于常规治疗仅等候名单条件）。本研究的参与者包括开始ERGT的完整意向治疗样本（跨治疗和等待条件; n = 51）。在初始评估时收集基线诊断和临床数据，并在治疗前、治疗后以及治疗后3个月和9个月时对DSH和自毁行为、情绪失调/回避和BPD症状（以及其他）进行结局测量。值得注意的是，人口统计学变量和参与者在社区中正在进行的治疗的特征对治疗反应的影响最小。然而，在与该ERGT相关的领域中，几个严重程度更高的指标（即，基线情绪失调和BPD标准、寿命和最近的DSH以及过去一年的住院和自杀企图）预测治疗期间和随访期间在主要治疗目标上的更好反应。同样，几种共同发生的疾病（即，社交恐惧症、惊恐障碍和B类人格障碍）预测在治疗或随访期间BPD症状的改善更大。最后，虽然同时发生的广泛性焦虑症、创伤后应激障碍、A群和C群人格障碍与随访期间较差的治疗反应相关，但大多数这些影响反映了在此期间缺乏持续改善（与症状恶化相比）。
Despite evidence for the efficacy of several treatments for deliberate self-harm (DSH) within borderline personality disorder (BPD), predictors of response to these treatments remain unknown. This study examined baseline demographic, clinical, and diagnostic predictors of treatment response to an adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD. A recent RCT provided evidence for the efficacy of this ERGT (relative to a treatment-as-usual only waitlist condition). Participants in this study include the full intent-to-treat sample who began ERGT (across treatment and waitlist conditions; n = 51). Baseline diagnostic and clinical data were collected at the initial assessment, and outcome measures of DSH and self-destructive behaviors, emotion dysregulation/avoidance, and BPD symptoms (among others) were administered at pretreatment, posttreatment, and 3- and 9-months posttreatment. Notably, both demographic variables and characteristics of participants' ongoing therapy in the community had minimal impact on treatment response. However, several indicators of greater severity in domains relevant to this ERGT (i.e., baseline emotion dysregulation and BPD criteria, lifetime and recent DSH, and past-year hospitalization and suicide attempts) predicted better responses during treatment and follow-up across the primary targets of treatment. Likewise, several co-occurring disorders (i.e., social phobia, panic disorder, and a cluster B personality disorder) predicted greater improvements in BPD symptoms during treatment or follow-up. Finally, although co-occurring generalized anxiety disorder, posttraumatic stress disorder, and cluster A and C personality disorders were associated with poorer treatment response during follow-up, most of these effects reflected a lack of continued improvements during this period (vs. worsening of symptoms).