Borderline Personality Disorder With Versus Without Alcohol Use Disorder: Comparing Impulsivity and Schema Modes

Boog, Michiel; Dugonjic, Helena; Arntz, Arnoud; Goudriaan, Anna E.; Wetering, Ben J M V D; Franken, Ingmar H. A.

doi:10.1521/pedi_2021_35_521

Cited by 5 publications

(3 citation statements)

References 66 publications

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“…Suicidal ideation and behavior in BPD are strongly predicted by pervasive instability of affective states (Rizk et al, 2019 ), plus high levels of intense negative mood and mood variability (Links et al, 2007 ). Mood variability appears to be related to trait impulsivity, which in turn is strongly related to schema modes in BPD (Boog et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes

et al. 2023

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Background Mood instability and risk-taking are hallmarks of borderline personality disorder (BPD). Schema modes are combinations of self-reflective evaluations, negative emotional states, and destructive coping strategies common in BPD. When activated, they can push patients with BPD into emotional turmoil and a dissociative state of mind. Our knowledge of the underlying neurocognitive mechanisms driving these changes is incomplete. We hypothesized that in patients with BPD, affective instability is more influenced by reward expectation, outcomes, and reward prediction errors (RPEs) during risky decision-making than in healthy controls. Additionally, we expected that these alterations would be related to schema modes. Methods Thirty-two patients with BPD and thirty-one healthy controls were recruited. We used an established behavioral paradigm to measure mood fluctuations during risky decision-making. The impact of expectations and RPEs on momentary mood was quantified by a computational model, and its parameters were estimated with hierarchical Bayesian analysis. Model parameters were compared using High-Density Intervals. Results We found that model parameters capturing the influence of RPE and Certain Rewards on mood were significantly higher in patients with BPD than in controls. These model parameters correlated significantly with schema modes, but not with depression severity. Conclusions BPD is coupled with altered associations between mood fluctuation and reward processing under uncertainty. Our findings seem to be BPD-specific, as they stand in contrast with the correlates of depressive symptoms. Future studies should establish the clinical utility of these alterations, such as predicting or assessing therapeutic response in BPD.

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Section: Introductionmentioning

confidence: 99%

Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes

et al. 2023

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“…On the contrary, the schema therapy was probably instrumental in Dennis’ recovery from substance abuse and also enabled him to stop using mood regulating psychiatric medication. Schema therapy has in fact been proposed as a suitable option for dual treatment of personality and substance use disorders, and there is tentative empirical support for its effectiveness (Boog et al, 2019; Kersten, 2012).…”

Section: Treatment Implications Of the Casementioning

confidence: 99%

Schema Therapy in the Nursing Home Setting: A Case Study of a Cognitively Impaired Patient

Botter

Gerritsen²,

Voshaar

2022

Clinical Case Studies

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The use of schema therapy to treat personality disorders in older adults is gaining scientific attention. Personality disorders are prevalent in one out of ten older adults and have a detrimental effect on quality of life. Although 24% or more of nursing home residents may have personality disorders, psychotherapeutic treatment options in the case of comorbid cognitive impairment have not yet been studied. This study concerns a 63-year-old care-dependent male nursing home resident with a personality disorder, a substance use disorder, and several cognitive impairments due to cerebrovascular disease, who presented with complaints of loneliness, low self-esteem, sleeping problems and anger outbursts. Schema therapy was delivered based on the schema mode model for a period of 27 months. Post-treatment assessment demonstrated a decrease in early maladaptive schemas and dysfunctional schema modes and improved personality functioning overall. Although situational psychological distress fluctuated throughout treatment, quality of life improved after 7 months and remained stable onwards. Presented complaints either remitted or strongly diminished. Substance use was also addressed and was in remission for the last 20 months of therapy. This case study suggests that schema therapy is a viable treatment for older adults with personality disorders who present with cognitive impairments in nursing homes.

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“…Because of the positive outcomes of ST for especially BPD patients (Giesen‐Bloo et al, 2006; Nadort et al, 2009) and the explanatory power of schema theory for problematic substance use (Boog et al, 2018; Boog et al, 2019), the present study was dedicated to investigating whether ST might be an effective therapy for patients with BPD and AD. Taking the studies of Ball and the criticism of Lee and Arntz as a starting point, we designed a phase 1 trial.…”

Section: Introductionmentioning

confidence: 99%

Schema therapy for patients with borderline personality disorder and comorbid alcohol dependence: A multiple‐baseline case series design study

Boog

Goudriaan

Wetering

et al. 2022

Clin Psychology and Psychoth

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This study tested the effectiveness of schema therapy (ST) for borderline personality disorder (BPD) and comorbid alcohol dependence (AD). Twenty patients participated in a case series study with multiple baselines. The baseline phase consisted of treatment as usual. It was followed by a case conceptualization phase, an experiential techniques phase and a behavioural change phase. Patients showed a significant decrease in BPD and AD symptoms; change was mainly accomplished in the experiential techniques phase, with medium to large effect sizes. Three months after termination of therapy, 68% of the patients had remitted from BPD, and the number of drinking days decreased clearly. This study shows that, although treatment is challenging in this group of patients, meaningful change can be obtained in patients with BPD and AD using ST.

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Borderline Personality Disorder With Versus Without Alcohol Use Disorder: Comparing Impulsivity and Schema Modes

Cited by 5 publications

References 66 publications

Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes

Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes

Schema Therapy in the Nursing Home Setting: A Case Study of a Cognitively Impaired Patient

Schema therapy for patients with borderline personality disorder and comorbid alcohol dependence: A multiple‐baseline case series design study

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