Change of Unresolved Attachment in Borderline Personality Disorder: RCT Study of Transference-Focused Psychotherapy

Buchheim, Anna; Hörz-Sagstetter, Susanne; Doering, Stephan; Rentrop, Michael; Schuster, Peter; Buchheim, Peter; Pokorný, Dan; Fischer-Kern, Melitta

doi:10.1159/000460257

Cited by 67 publications

(58 citation statements)

References 8 publications

(14 reference statements)

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“…Changes after psychodynamic treatment included symptomatic improvement and additionally significant reduction of unresolved attachment representations, which was also found in Buchheim et al [9]. In the EEG data, LPPs were reduced in patients at baseline, in contrast to our assumptions.…”

Section: Correlation Between Eeg and Clinical Datasupporting

confidence: 86%

Modulation of Gamma Band Activity and Late Positive Potential in Patients with Chronic Depression after Psychodynamic Psychotherapy

Buchheim

Labek

Taubner

et al. 2018

Psychother Psychosom

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Section: Correlation Between Eeg and Clinical Datasupporting

confidence: 86%

Modulation of Gamma Band Activity and Late Positive Potential in Patients with Chronic Depression after Psychodynamic Psychotherapy

Buchheim

Labek

Taubner

et al. 2018

Psychother Psychosom

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“…As expected, patients were more often classified as “disorganized” with “unresolved trauma” in comparison to HC subjects. A number of studies (Buchheim et al, ; Buchheim & George, ; Fonagy et al, ; Levy et al, ) also report that unresolved attachment is overrepresented in BPD. BPD patients and HC did not differ in the number of extrafamilial but in the number of intrafamilial trauma, including emotional neglect, physical, or sexual violence.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we assessed attachment representations at the beginning of DBT treatment only. Previous studies demonstrated that attachment representations change after evidence‐based psychodynamic interventions, that is, transference focused psychotherapy (Clarkin, Yeomans, & Kernberg, ) compared with TAU (Buchheim et al, ; Levy et al, ). Therefore, it would be challenging to evaluate changes of attachment status after DBT therapy, to test if results are comparable, because techniques and mechanisms of change are pretty different (Chio‐Kain, Albert, & Gunderson, ; Stoffers et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The attachment system is supposed to influence the individual's interpersonal perception and behaviour (Bretherton & Munholland, ). Several studies demonstrated the central role of attachment patterns in the development of psychiatric disorders (Bakermans‐Kranenburg & van IJzendoorn, ; Buchheim et al, ; Buchheim & George, ; Dozier, Stovall‐McClough, & Albus, ). They showed that a disruption in early attachment relationships through experiences of loss and trauma may influence later pathology by leading to a series of disturbed mental representations over the lifespan.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have examined how attachment representations or styles may relate to the psychotherapy outcome (e.g., Levy, Ellison, Scott, & Bernecker, ; Taylor, Rietzschel, Danquah, & Berry, ). In various studies, successful psychodynamic psychotherapy was associated with a secure or organized attachment representation (Buchheim et al, , ; Levy et al, ) or style (Meyer, Pilkonis, Proietti, Heape, & Egan, ; Mosheim et al, ; Stefini et al, ; Strauss et al, ). Reversely, there is evidence that higher attachment anxiety may be predictive of poorer psychodynamic treatment outcomes, among both preoccupied patients with a variety of clinical disorders including BPD (Fonagy et al, ; Strauss et al, ) and fearful‐avoidant patients with major depression (Reis & Grenyer, ).…”

Section: Introductionmentioning

confidence: 99%

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The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder

Bernheim

Gander

Keller

et al. 2019

Clin Psychology and Psychoth

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Attachment characteristics play a key role in understanding borderline‐specific problems with respect to childhood maltreatment. The aim of this study was to investigate how attachment representations may influence the trajectory of change in a 1‐year outpatient dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD). Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP) before treatment. Borderline and global symptom severity and interpersonal problems were examined before, during, and after completing the intervention. Analysis of variance and stepwise hierarchical regression analyses were used to explore the course of symptomatology. As expected, BPD patients displayed a predominance of unresolved attachment in the AAP compared with HC, by showing a lack of ability to integrate attachment related trauma. Whereas both resolved and unresolved attachment groups revealed significant improvement in symptom severity during treatment, dimensional AAP scores showed differences. Patients with higher scores in “synchrony” demonstrated more indicators of mutual care in their narratives to dyadic pictures and displayed a significantly stronger decrease of interpersonal problems than patients with lower synchrony scores. Assessing attachment representations prior to DBT might provide a helpful insight into individual attachment related resources or lack of these capacities. Responsiveness and synchrony in dyadic interactions with significant others are crucial for healthy interpersonal relations. A stronger therapeutic focus on the patient's capacity to show synchrony in dyadic attachment situations might improve the patient's interpersonal problems towards sensitive and mutual interaction.

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Psychological therapies for people with borderline personality disorder

Storebø

Stoffers‐Winterling

Völlm

et al. 2020

Cochrane Database of Systematic Reviews

232

244

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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of psychological therapies for people with borderline personality disorder (BPD). B A C K G R O U N D Description of the condition Borderline personality disorder (BPD) is a condition first recognised in the 20th century (Gunderson 2009). Historically, the term BPD was coined by Adolph Stern to describe a condition in the 'borderland' between psychosis and neurosis (Stern 1938). Subsequent psychoanalytic contributions (especially that of Kernberg 1975) have reaffirmed this distinction, emphasising that the capacity to test reality remains grossly intact but is subject to subtle distortions, especially under stress. According to current diagnostic criteria, BPD is characterised by a pervasive pattern of instability in affect regulation, impulse control , interpersonal relationships, and self-image (APA 2013; WHO 1993). Clinical hallmarks include emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies (Fonagy 2009; Lieb 2004). Whereas some authors have suggested that it is a variant of affective disorders (Akiskal 2004), others claim that it is only the causes of these diseases that partially overlap in BPD (Paris 2007). Despite the difficulties in defining and delimiting the condition, BPD is still being widely researched. Its importance stems from the considerable psychological suffering of the persons concerned (

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Change of Unresolved Attachment in Borderline Personality Disorder: RCT Study of Transference-Focused Psychotherapy

Cited by 67 publications

References 8 publications

Modulation of Gamma Band Activity and Late Positive Potential in Patients with Chronic Depression after Psychodynamic Psychotherapy

Modulation of Gamma Band Activity and Late Positive Potential in Patients with Chronic Depression after Psychodynamic Psychotherapy

The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder

Psychological therapies for people with borderline personality disorder

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