Basal Exposure Therapy: A New Approach for Treatment-Resistant Patients with Severe and Composite Mental Disorders

Abstract

New treatment approaches are needed for patients with severe and composite mental disorders who are resistant to conventional treatments. Such treatment-resistant patients often have diagnoses of psychotic or bipolar disorders or severe personality disorders and comorbid conditions. In this study, we evaluate basal exposure therapy (BET), a novel ward-integrated psychotherapeutic approach for these patients. Central to BET is the conceptualization of undifferentiated existential fear as basic to the patients’ problem, exposure to this fear, and the therapeutic platform complementary external regulation, which integrates and governs the totality of interventions throughout the treatment process. BET is administered at a locked-door ward with 6 patient beds and 13.5 full-time employees, including a psychiatrist and 2 psychologists. Thirty-eight patients who had completed BET were included, all but two being female, mean age 29.9 years. Fourteen patients had a diagnosis of schizophrenia or schizoaffective disorder (F20/25), eight had bipolar disorder or recurrent depressive disorder (F31/33), eight had diagnoses in the F40–48 domain (neurotic, stress-related, and somatoform disorders), five were diagnosed with emotionally unstable personality disorder (F60.3), and three patients had other diagnoses. Twenty of the patients (53%) had more than one ICD-10 diagnosis. Average treatment time in BET was 13 months, ranging from 2 to 72 months. Time-series data show significant improvements in symptoms and functioning from enrollment to discharge, with effect sizes at 0.76 for the Dissociation Experience Scale, 0.93 for the Brief Symptom Inventory, 1.47 for the Avoidance and Action Questionnaire, and 1.42 and 1.56, respectively, for the functioning and symptom subscales of the Global Assessment of Functioning Scale. In addition, the patients used significantly less antiepileptic, antipsychotic, anxiolytic, and antidepressant medications at discharge than at treatment enrollment. Patient improvement across treatment was associated with the following duration of time in BET, the successful completions of the exposure component of BET, positive changes in experiential avoidance as measured with the Acceptance and Action Questionnaire, and high symptom levels and low levels of functioning at treatment start. The findings indicate that BET may be a promising inpatient psychotherapeutic approach for previously treatment-resistant patients with severe and comorbid conditions.

Reduksjon av unngåelsesatferd og innleggelser grunnet villet egenskade etter Basal Eksponeringsterapi

“…Slik unngåelse kan føre til positive feedback-sløyfer som over tid innskrenker pasientenes kapasitet til å håndtere uønskede indre opplevelser. Samtidig kan helsevesenets forsøk på symptomlindring og atferdsregulering over tid ha bidratt til å vikle pasienten inn i et marginaliserende samspill som har svekket deres evne til egenmestring Heggdal et al, 2016;Heggdal et al, 2015). Mål-settingen i BET er å hjelpe pasientene til å bryte ut av marginaliserende samspillsmønstre med helsevesenet.…”

“…Dette kan gjøre at helsepersonell forsøker å kontrollere pasientens atferd og føre til gjentatte innleggelser på sykehus (McAllister, 2003). Behandlingshistorikken til pasientene i BET er vanligvis preget av helsevesenets repeterende forsøk på å regulere symptomer og atferd ved bruk av psykofarmakologiske intervensjoner og tvangstiltak Heggdal et al, 2016;Heggdal et al, 2015). Mens BET-pasientene opplevde at de tidligere ble fratatt ansvar for egne handlinger, er ambisjonen i BET å la ansvaret ligge hos pasienten Heggdal et al, 2016;Heggdal et al, 2015).…”

“…Behandlingshistorikken til pasientene i BET er vanligvis preget av helsevesenets repeterende forsøk på å regulere symptomer og atferd ved bruk av psykofarmakologiske intervensjoner og tvangstiltak Heggdal et al, 2016;Heggdal et al, 2015). Mens BET-pasientene opplevde at de tidligere ble fratatt ansvar for egne handlinger, er ambisjonen i BET å la ansvaret ligge hos pasienten Heggdal et al, 2016;Heggdal et al, 2015). En slik ansvarsplassering er i tråd med anbefalt terapeutisk praksis og nasjonale retningslinjer for behandling av kronisk suicidale pasienter (Paris, 2007;Sosial-og helsedirektoratet, 2008;Stangeland, 2012).…”

Drug-free after basal exposure therapy

“…Basal exposure therapy is a psychosocial inpatient therapy form specifically developed for patients with severe and composite mental disorders (8). Those who are admitted tend to have a treatment history that includes numerous or lengthy inpatient admissions in mental health care, long-standing use of psychotropic drugs, polypharmacy (permanent use of two or more psychotropic drugs simultaneously) and extensive use of coercion (8)(9)(10).…”

“…Those who are admitted tend to have a treatment history that includes numerous or lengthy inpatient admissions in mental health care, long-standing use of psychotropic drugs, polypharmacy (permanent use of two or more psychotropic drugs simultaneously) and extensive use of coercion (8)(9)(10). Most of them are described as treatment-resistant after having gone through two or more treatment attempts adequate for their diagnosis and including psychotropic drugs, with no improvement.…”