Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy

Euler, Sebastian; Stalujanis, Esther; Allenbach, Gilles; Kolly, Stéphane; Roten, Yves de; Despland, Jean‐Nicolas; Kramer, Uëli

doi:10.1080/10503307.2018.1497214

Cited by 18 publications

(13 citation statements)

References 65 publications

(74 reference statements)

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“…ODF and maladaptive defenses displayed a significant between-patient effect on anxiety symptoms, with ODF explaining 33% of outcome variance and maladaptive defenses explaining 26%, while neurotic defenses did not. This pattern was also found by Euler et al (2018) and Perry (2001) who reported a significant change on the level of maladaptive defenses first. One possible explanation as put forward by Vaillant (1993) is that defenses change up the hierarchy in a stepwise fashion with maladaptive defenses moving up to neurotic and eventually adaptive defenses.…”

Section: Discussionsupporting

confidence: 73%

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Babl

Berger

Holtforth

et al. 2019

Psychotherapy Research

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There is a great need to identify predictors of treatment response, and the analysis of defense mechanisms is a promising approach. Defensive functioning may influence psychotherapy outcome in two ways: First, when it is generally higher or lower for some patients relative to others and second, as it shifts in individual patients over time. The present study examined both within-and between patient effects of defenses using hierarchical linear modeling. Forty-seven patients diagnosed with depression, anxiety, or adjustment disorders received 25±3 sessions of integrative cognitive-behavioral therapy in a university outpatient clinic. The Defense Mechanism Rating Scale (DMRS) was used to assess defenses in the 1 st , 8 th , 16 th , and 24 th session and relate them to symptom severity of depression and anxiety. A higher number of adaptive defense mechanisms was associated with less severe depressive symptoms during treatment while a higher number of immature defenses was related to more severe depressive and anxiety symptoms. An increase in adaptive and a decrease in immature defenses over the course of treatment predicted symptom reduction of depression whereas a decrease in neurotic and immature defenses was associated with reductions in anxiety symptoms. Our results empirically support defensive functioning as a mechanism of change in psychotherapy.

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Section: Discussionsupporting

confidence: 73%

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Babl

Berger

Holtforth

et al. 2019

Psychotherapy Research

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“…Change in insight and in defense mechanisms are sensitive variables which have mostly been studied in psychodynamic psychotherapy (67,68), as well as dialectical-behavior therapy (69). Insight was studied using a self-report measure in a sample where half presented with a PD ((68); N = 100): increase in the quality of insight mediated symptomatic relief.…”

Section: Change In Insight and Defense Mechanismsmentioning

confidence: 99%

“…Defense mechanisms have been studied using observer-rated methodology, showing that clients in psychotherapy move up towards a more mature and self-reflective level of defensive functioning. Such changes were also studied in the context of brief dialectical-behavior therapy for DBT where increased adaptiveness in defensive functioning could be observed, but its relationship with symptom change remained complex (69). Defense mechanisms and insight are important process features explaining some amount of symptom decrease in treatments for personality disorders.…”

Section: Change In Insight and Defense Mechanismsmentioning

confidence: 99%

How Personality Disorders Change in Psychotherapy: a Concise Review of Process

Kramer

Beuchat

Grandjean

et al. 2020

Curr Psychiatry Rep

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Purpose of review: The present review summarizes the current state of the art in psychotherapy processes during treatments for clients with personality disorders. We outline some methodological challenges in the discipline of process research, give a brief historical account on process research, and then focus on specific processes studied from an empirical perspective. Recent findings: The current review acknowledges the centrality of the therapeutic relationship, in particular the therapeutic alliance, therapist empathy and responsiveness in explaining outcome across treatment modalities for personality disorders. The review describes evidence from three overall, and overlapping, lines of inquiry that have garnered scientific interest in the past years. Summary: Emotional change (regulation, awareness and transformation), socio-cognitive change (mentalizing, meta-cognition and interpersonal patterns), and increase in insight and change in defense mechanisms. Evidence is strong that these processes contribute to healthy change in treatments for personality disorders, in particular borderline personality disorder. Avenues of future studies are outlined.

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“…The skills acquisition allows patients to achieve better emotional and behavioral control, which translates primarily into reduced NSSI and suicide (Neacsiu et al, 2010). Moreover, two studies showed that DBT with skills training is more efficient in reducing NSSI than DBT without skills training (Linehan et al, 2015; Euler et al, 2018).…”

Section: Skills Training Groupsmentioning

confidence: 99%

Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT

Prada¹,

Perroud²,

Rüfenacht³

et al. 2018

Front. Psychol.

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One of the most problematic aspects of borderline personality disorder resides in repeated non-suicidal self-injury (NSSI) and suicide attempts. These behaviors constitute the prime therapeutic target and a factor that complicates patient care, namely in terms of therapeutic continuity. It has been demonstrated that Dialectical Behavior Therapy (DBT) is efficient in reducing the symptomatology of this disorder, as well as NSSI and suicide. DBT is a multi-component psychotherapeutic treatment, and the effectiveness of its individual constituents is therefore a relevant question. Studies comparing its various components (individual therapy, group therapy, and standard DBT) have not revealed any marked difference between them, other than a tendency toward improved patient retention rates in the standard version of the treatment. The aim of this study is to review the various components of DBT and their constituent parts, in order to highlight the importance of focusing on self-harm behaviors within the therapy as a whole. Although therapeutic strategies may differ and target directly suicide or NSSI, managing the quality of life, and the persistence of the therapeutic alliance (and of the interpersonal alliance) is equally important in terms of treatment efficacy.

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Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy

Abstract: Although DBT does not explicitly target defense mechanisms, skills training may have favorable effects on defense function in BPD. Our findings contribute to an integrative understanding of mechanisms of change in BPD psychotherapy.

Cited by 18 publications

References 65 publications

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

How Personality Disorders Change in Psychotherapy: a Concise Review of Process

Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT

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