Impaired Maintenance of Interpersonal Synchronization in Musical Improvisations of Patients with Borderline Personality Disorder

Abstract

Borderline personality disorder (BPD) is a serious and complex mental disorder with a lifetime prevalence of 5.9%, characterized by pervasive difficulties with emotion regulation, impulse control, and instability in interpersonal relationships and self-image. Impairments in interpersonal functioning have always been a prominent characteristic of BPD, indicating a need for research to identify the specific interpersonal processes that are problematic for diagnosed individuals. Previous research has concentrated on self-report questionnaires, unidirectional tests, and experimental paradigms wherein the exchange of social signals between individuals was not the focus. We propose joint musical improvisation as an alternative method to investigate interpersonal processes. Using a novel, carefully planned, ABA′ accompaniment paradigm, and taking into account the possible influences of mood, psychotropic medication, general attachment, and musical sophistication, we recorded piano improvisations of 16 BPD patients and 12 matched healthy controls. We hypothesized that the insecure attachment system associated with BPD would be activated in the joint improvisation and manifest in measures of timing behavior. Results indicated that a logistic regression model, built on differences in timing deviations, predicted diagnosis with 82% success. More specifically, over the course of the improvisation B section (freer improvisation), controls' timing deviations decreased (temporal synchrony became more precise) whereas that of the patients with BPD did not, confirming our hypothesis. These findings are in accordance with previous research, where BPD is characterized by difficulties in attachment relationships such as maintaining strong attachment with others, but it is novel to find empirical evidence of such issues in joint musical improvisation. We suggest further longitudinal research within the field of music therapy, to study how recovery of these timing habits are related to attachment experiences and interpersonal functioning in general.

Music Therapy During COVID-19: Changes to the Practice, Use of Technology, and What to Carry Forward in the Future

“…When patients, who may have a broad range of psychopathologies and severity profiles, create music, their performance contains information that relates to underlying affective and communicative processes that occur during music making. For example, in a study with Borderline Personality Disorder (BPD) patients-patients who have trouble with interpersonal relationships, emotional instability, and impulsive behavior-music information retrieval (MIR) techniques were used to analyze improvizations in which a therapist and patient play in tandem on a single piano (Foubert et al, 2017). This approach yielded clear disparities between BPD patients and the healthy control group, and affords a new way of assessing non-verbal interactions and cognitive processes.…”

Feasibility of emotion-regulating improvisational music therapy for young adult students with depressive symptoms: A process evaluation

“…Monitoring of treatment integrity and musical components to synchronise needs improvement, which can be assisted by video or audio recording. Using multiple perspectives, music therapists, clients, and their network members may evaluate data Boendermaker & Goense, 2017) and the inclusion of video or audio analysis may lead to a better understanding of what happens in sessions and how this corresponds to people's reports of it (Foubert et al, 2017).…”

Significant Moments in Improvisational Music Therapy

“…Body movement and gesture can help add meaning and context to verbal dialogue and are also used as a primary form of communication for some individuals (Caldwell, 2013). Temporal elements found within movement patterns can offer additional insight into communicative intent and synchronicity between client and therapist within musical and nonmusical interactions (Foubert et al, 2017;Stern, 2010). Caldwell (2013) posited that body movement and behavior have an underlying meaning that could be uncovered through investigation of the environment and interactional patterns.…”

“…By experiencing full presence and openness to communication being transmitted from a variety of modalities, the therapist can gain a deeper understanding of a client's internal experience (Caldwell, 2013;Dillard, 2006;Scheiby, 2005;Seabrook, 2019;Stern, 2010;Swaney, 2017;Swaney, 2020). Characteristics of musical interactions, in body movement, rhythm, and melody, can offer snapshots of the therapeutic relationship at a given moment in time and demonstrate a client's growth over time (Caldwell, 2013;Foubert et al, 2017;Strehlow & Linder, 2014;Swaney, 2017;Swaney, 2020). Strehlow and Lindner (2014) identified interactional patterns present in improvisational interactions with clients diagnosed with borderline personality disorder (BPD).…”

“…Interactional patterns were identified and defined in terms of musical characteristics, relation to the therapist, therapist's feelings and inner thoughts, and the function of the music. Additionally, interpersonal temporal synchronicity be-tween the client and therapist has been used as a method of assessing an individual's ability to relate to another person (Foubert et al, 2017;Kleinlooh et al, 2021). Continued participation in successful interpersonal temporal synchronicity may have implications in improving temporal relational strategies as they impact attachment experiences.…”