A comparison of women who continue and discontinue treatment for borderline personality disorder

Webb, Daniel; McMurran, Mary

doi:10.1002/pmh.69

Cited by 33 publications

(23 citation statements)

References 18 publications

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“…The high dropout rate we found in an early phase of BPD is widely supported by previous studies and probably depends on dysfunctional personality traits of these patients that mainly affect interpersonal relationships 3–8 . The present research confirms these data and shows that dropout is strongly associated with patients' subjective perception, which is assessed through PAEQ and includes: therapeutic relationship, patients' expectations regarding the effectiveness of the treatment, and their motivation for change.…”

Section: Discussionsupporting

confidence: 89%

“…S ATISFACTORY THERAPEUTIC COMPLIANCE among patients with personality disorder (PD) is challenging and notoriously difficult to achieve in all treatment settings and especially when a borderline personality disorder (BPD) diagnosis is present. [1][2][3] In particular, dropout, ranging from 50% to 60%, mainly occurs in the early phase of treatment. [4][5][6] Despite the importance of this problem, very little research on predictors of premature termination of treatment for BPD has been carried out.…”

mentioning

confidence: 99%

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Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: A preliminary study

Martino

Menchetti

Pozzi³

et al. 2012

Psychiatry Clin Neurosci

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Aim: The aim of this study was to identify factors that may affect treatment retention in a 1‐year psychosocial program for adult personality disorders. Methods: The sample consists of patients admitted to the Adult Personality Disorder Outpatient Programme of the Bologna Community Mental Health Centre in the period 2003–2008. At the beginning of the program, patients were evaluated through a comprehensive assessment including sociodemographic form, diagnostic interviews and self‐report questionnaires. Patients who dropped out from treatment were retrospectively compared with patients who completed the program. Results: Out of 39 patients enrolled in the program, 20 (51.3%) dropped out and 19 (48.7%) completed the treatment. Out of 20 patients who dropped out, 14 terminated the treatment within the first 2 months. The dropout group and the group which remained showed significant differences in diagnosis (borderline personality disorder [BPD]), demographic data (age, time from first contact with psychiatric services), clinical variable (impulsiveness) and subjective experience (motivation, treatment expectation, therapeutic relation perception and barriers to access). BPD and subjective evaluation were found to be predictors of premature termination in the sample. In detail, BPD patients who experienced a less satisfactory therapeutic relationship and reported many external problems were more likely to drop out of the program. Conclusion: Important factors contributing to dropout were identified, with potential implication for clinical practice. Further efforts need to be made to find ways to retain BPD patients who find the first subjective experience of the service more problematic.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: A preliminary study

Martino

Menchetti

Pozzi³

et al. 2012

Psychiatry Clin Neurosci

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“…), and that non‐completion is associated with poorer clinical outcomes (Karterud et al . , Webb & McMurran ) and increased service costs (Sampson et al . ).…”

Section: Discussionmentioning

confidence: 99%

“…Reviews have shown that one third of people with PD do not complete treatment (McMurran et al 2010), and that non-completion is associated with poorer clinical outcomes (Karterud et al 2003, Webb & McMurran 2009) and increased service costs (Sampson et al 2013). This information was the catalyst for developing this training programme to improve engagement and prevent noncompletion.…”

Section: Discussionmentioning

confidence: 99%

Readiness Enhancement Management Strategies (REMS): a proof of concept and evaluation feasibility study of staff training to improve service engagement by people with personality difficulties

Clarke

Jinks

McMurran

2015

Psychiatric Ment Health Nurs

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One third of people diagnosed with PD do not complete treatment and non-completion is associated with poorer clinical outcomes. Equipping staff to be better able to engage this client group is important, and web-based, self-directed learning is a potentially cost-effective way to train staff. This study examined the implementation of a web-based training programme called Readiness Enhancement Management Strategies (REMS) in three types of service. Completion rates were 94.4% in community health services; 92.3% in prison offender health services; and 46.5% in probation services. Staff found the content of REMS acceptable and useful. This study demonstrated that staff in NHS and criminal justice settings can complete REMS, but staff in probation services are challenged by time pressures and limited computer access. Staff at probation sites were less familiar with PD issues compared with the NHS staff. A web-based staff training programme called Readiness Enhancement Management Strategies (REMS) was developed to promote the engagement of people with personality difficulties in treatment. This 'proof of concept' study examined the REMS implementation process, its acceptability and the feasibility of using service data for future evaluation. Staff in six services working with people diagnosed with personality disorder or undiagnosed people with personality difficulties were eligible to participate: two community health services, two prison offender health services and two probation services. Of 92 eligible staff, 74 were available to undertake REMS. These staff completed knowledge and acceptability surveys and rated service user engagement with treatment. The proportion of treatment sessions attended by service users was collected for a 30-week period. REMS completion rates were community - 94.4%, prison - 92.3% and probation - 46.5%. Three quarters of participants rated REMS as 7 out of 10 or higher. All teams were able to provide service data for the study period. REMS can be implemented by National Health Services (NHS) staff in community and prison settings, but technology issues need to be resolved in probation services. REMS may be useful for NHS staff working with difficult to engage clients, and an evaluation is a feasible prospect.

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“…This review also identified studies that showed non-completion of treatment to be associated with poorer clinical outcomes. Compared with treatment completers, those who did not complete treatment were shown to be hospitalized more frequently and to spend more days in hospital [4,5]. Poor attendance also compromises service efficiency and cost-effectiveness through poor use of resources and consequent increased costs associated with treatments [1].…”

Section: Introductionmentioning

confidence: 99%

The addition of a goal-based motivational interview to treatment as usual to enhance engagement and reduce dropouts in a personality disorder treatment service: results of a feasibility study for a randomized controlled trial

McMurran

Whitham

Hedges

2013

Trials

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BackgroundThere are high rates of treatment non-completion for personality disorder and those who do not complete treatment have poorer outcomes. A goal-based motivational interview may increase service users’ readiness to engage with therapy and so enhance treatment retention. We conducted a feasibility study to inform the design of a randomized controlled trial. The aims were to test the feasibility of recruitment, randomization and follow-up, and to conduct a preliminary evaluation of the effectiveness of the motivational interview.MethodsPatients in an outpatient personality disorder service were randomized to receive the Personal Concerns Inventory plus treatment as usual or treatment as usual only. The main randomized controlled trial feasibility criteria were recruitment of 54% of referrals, and 80% of clients and therapists finding the intervention acceptable. Information was collected on treatment attendance, the clarity of therapy goals and treatment engagement.ResultsThe recruitment rate was 29% (76 of 258). Of 12 interviewed at follow-up, eight (67%) were positive about the Personal Concerns Inventory. Pre-intervention interviews were conducted with 61% (23 out of 38) of the Personal Concerns Inventory group and 74% (28 out of 38) of the treatment as usual group. Participants’ therapy goals were blind-rated for clarity on a scale of 0 to 10. The mean score for the Personal Concerns Inventory group was 6.64 (SD = 2.28) and for the treatment as usual group 2.94 (SD = 1.71). Over 12 weeks, the median percentage session attendance was 83.33% for the Personal Concerns Inventory group (N = 17) and 66.67% for the treatment as usual group (N = 24). Of 59 eligible participants at follow-up, the Treatment Engagement Rating scale was completed for 40 (68%). The mean Treatment Engagement Rating scale score for the Personal Concerns Inventory group was 6.64 (SD = 2.28) and for the treatment as usual group 2.94 (SD = 1.71). Of the 76 participants, 63 (83%) completed the Client Service Receipt Inventory at baseline and 34 of 59 (58%) at follow-up.ConclusionShortfalls in recruitment and follow-up data collection were explained by major changes to the service. However, evidence of a substantial positive impact of the Personal Concerns Inventory on treatment attendance, clarity of therapy goals and treatment engagement, make a full-scale evaluation worth pursuing. Further preparatory work is required for a multisite trial.Trial registrationClinicalTrials.Gov.UK Identifier - NCT01132976

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A comparison of women who continue and discontinue treatment for borderline personality disorder

Cited by 33 publications

References 18 publications

Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: A preliminary study

Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: A preliminary study

Readiness Enhancement Management Strategies (REMS): a proof of concept and evaluation feasibility study of staff training to improve service engagement by people with personality difficulties

The addition of a goal-based motivational interview to treatment as usual to enhance engagement and reduce dropouts in a personality disorder treatment service: results of a feasibility study for a randomized controlled trial

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