The Feasibility and Acceptability of the Mediational Intervention for Sensitizing Caregivers for Mothers with Borderline Personality Disorder

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Project Summary/Abstract Extant data suggest that the children of mothers with Borderline Personality Disorder (BPD) are at particular risk for a variety of poor psychosocial outcomes, in part because research has demonstrated that mothers with BPD have difficulty forming secure attachment relationships with their children. One avenue for interrupting the intergenerational transmission of psychopathology from mothers to offspring is through scaffolding parenting in mothers. While parenting programs have been developed for most psychiatric disorders, personality pathology has lagged behind. The Mediational Intervention for Sensitizing Caregivers (MISC) has been used in other high-risk populations impacted by attachment disruptions and holds promise for use with mothers with BPD. However, before MISC can be adapted for mothers with BPD, it is first important to evaluate the feasibility and acceptability of MISC for this population. The objective of this application is to use the ADAPT-ITT model to evaluate the feasibility and acceptability of MISC for mothers with BPD and to identify key elements that should be integrated in a future adaptation of MISC for mothers with BPD. The approach of this application will execute the first three steps of the ADAPT-ITT model. Aim 1 (Step 1 of ADAPT-ITT). Quantitative Assessment (phase 1) of attachment and related mechanisms will be conducted with 100 mothers with BPD and 100 mothers without BPD. Qualitative Assessment (phase 2) of parenting and intervention needs will be conducted with 15 mothers with BPD, from phase 1. Aim 2 (Step 2 of ADAPT-ITT model). The Decision to adapt MISC for mothers with BPD will be made by examining the feasibility of MISC for mothers with BPD. Aim 3 (Step 3 of ADAPT-ITT model). Specific intervention targets and delivery features for future Adaptation of MISC will be identified by having the 15 participants from Aim 1-phase 2 participate in theatre testing of MISC. The applications central hypotheses are as follows. Aim 1: Mothers with BPD will exhibit parenting factors which put their children at risk for poor psychosocial outcomes, will have a perceived need for a parenting intervention, and will have specific preferences for treatment targets and delivery. Aim 2: MISC is feasible for mothers with BPD and appropriate for adaptation. Aim 3: MISC is acceptable for mothers with BPD and feedback focus groups will identify specific refinements to MISC’s content, materials and delivery that will need to be incorporated into a future adaptation of MISC. The proposed research is in line with the third strategic objective of the NIMH, the prevention of mental illness. This fellowship will serve as preliminary data for a future F32 or K granted to the PI to adapt MISC materials for use with mothers with BPD. Successful adaptation of MISC- BPD would allow a practical attachment-based intervention to be introduced to the field of personality pathology, potentially improving the quality of life of mothers struggling with BPD and their children. Finally, receiving this fellowship will strengthen the training of a junior researcher as she develops an independent line of translational research, regardless of whether she pursues MISC in particular.