A design for process-outcome psychotherapy research in adolescents with Borderline Personality Pathology

Abstract

Underage patients with Borderline Personality Pathology (BPP) are in need of specialised psychotherapeutic treatment. A handful of these treatments, including Adolescent Identity Treatment (AIT) and Dialectical Behavior Therapy for Adolescents (DBT-A), have been adapted for adolescent patients. Psychotherapy research has shown that the outcome of different psychotherapeutic approaches can be very similar despite conceptual and practical differences between the theoretical models. Therefore, to understand what really works in psychotherapy, it is necessary to investigate the psychotherapeutic process and its effects on the patient.This paper presents a study design for process-outcome research, integrating (1) a classical outcome design, comparing AIT and DBT-A in a non-inferiority trial assessing changes in psychosocial functioning at 12 months after baseline as primary outcome; and (2) a process research design, addressing multiple BPP and psychotherapy relevant factors. These factors include well-studied generic variables such as the psychotherapeutic alliance, more recent approaches such as video-based identification of significant therapeutic events, as well as more experimental approaches such as psychophysiological markers measured during the therapeutic sessions.The use of repeated measures and the methodological pluralism which includes event and micro-process analyses has been recommended for psychotherapy research aiming at a better understanding of the interplay of factors at work to narrow the gap between research and practice in this field.

Movement Synchrony in the Psychotherapy of Adolescents With Borderline Personality Pathology – A Dyadic Trait Marker for Resilience?

“…The study is part of the multicenter study “Evaluation of Adolescent Identity Treatment” ( Schmeck et al, 2018 ; Zimmermann et al, 2018 ) that has been registered at clinicaltrials.gov (NCT02518906). Current analyses are based on the data collected at one participating center (Psychiatric Hospitals of the University of Basel using AIT).…”

“…The following inclusion criteria were applied for the patients: age 13–19 years; ≥3 BPD criteria according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis II Personality Disorders ( First et al, 1997 ), and identity diffusion according to the Assessment of Identity Development in Adolescence (total t -score ≥ 60; Goth et al, 2012 ). Applied exclusion criteria were IQ < 80, psychotic disorders, pervasive developmental disorders, severe somatic or neurological disorders, severe and persistent substance addiction, antisocial personality disorder and necessity for inpatient treatment (for details, see Zimmermann et al, 2018 ).…”

“…The therapeutic process with BPD patients is often challenging because symptoms of BPD (e.g., rejection sensitivity) can hinder the construction of a good therapeutic relationship ( McMain et al, 2015 ) through an increased risk of ruptures of the therapeutic alliance ( Schenk et al, 2019 , 2020 ). Psychotherapy process research investigates active ingredients of therapeutic interventions and helps improve therapeutic approaches, as well as informing psychotherapists about the mechanisms of change and how they may leverage these actions ( Hardy and Llewelyn, 2015 ; Zimmermann et al, 2018 ).…”

Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance

“…Inclusion criteria of the parental study were an identity diffusion assessed with the Assessment of Identity Development in Adolescence (AIDA; T-Score ≥60), (Goth et al, 2012) and Outcome 2019; 22:348] Article BPD criteria assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), (First, Gibbon, Spitzer, Williams, & Benjamin, 1997). Exclusion criteria were IQ<80, psychotic disorders, pervasive developmental disorders, severe somatic or neurological disorders, severe and persistent substance addiction, antisocial personality disorder and necessity for inpatient treatment (for details, Zimmermann et al, 2018). Patient demographics and baseline pathology are provided in Table 1.…”

Supervised Speaker Diarization Using Random Forests: A Tool for Psychotherapy Process Research

“…This study is performed as part of the EAST psychotherapy study [ clinicaltrials.gov : NCT02518906; Zimmermann et al (2018) ].…”