Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention

Crawford, Mike; Thana, Lavanya; Parker, Jennie; Turner, Oliver; Carney, Aidan; McMurran, Mary; Moran, Paul; Weaver, Timothy; Barrett, Barbara; Roberts, Susan C.; Claringbold, Amy; Bassett, Paul; Sanatinia, Rahil; Spong, Amanda

doi:10.1192/bjo.2020.7

Cited by 11 publications

(12 citation statements)

References 37 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The role of specialist services being to support generic services and to provide specialized interventions for those with the most severe conditions and those most at risk [59]. Our findings support calls for generic mental health services to increase availability of holistic interventions [60,61], and there are now novel CEN-specific holistic psychological interventions being evaluated in generic mental health services which are showing strong clinical promise [61,62].…”

Section: Holistic Approachessupporting

confidence: 66%

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background There is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users’ views and co-production initiatives have had little impact on the development of interventions and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs. Methods A co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data. Results Participants reported some experiences of good practice but also of experiences of severely stigmatising interventions, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised and compassionate way and care that is trauma-informed. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs. Conclusions Relational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with people with relevant lived experience, their carers and the professionals who support them.

show abstract

Section: Holistic Approachessupporting

confidence: 66%

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…The extent of inappropriate polypharmacy (Aronson, 2006) will be determined. ; promotion of environmental interventions such as social prescribing (Bickerdike et al, 2017; Tyrer & Boardman, 2020) and nidotherapy (Ranger et al, 2009; Tyrer & Tyrer, 2018) to reinforce the advantages of personality strengths; greater liaison with primary care services to ensure continuity of planned interventions when patients are discharged from the community team; shorter treatments for those with emotional lability recently introduced and found to be effective, such as Structured Psychological Support (Crawford et al, 2020); promotion of personal interventions that are highly specific to the individuals concerned (Coulter et al, 2015); these to include trauma‐focused interventions for those with comorbid PTSD or complex PTSD. It is not expected that most of these treatments will have an impact in as little as 6 or 12 months but if greater knowledge of their potential is achieved it will have an impact on function and satisfaction.…”

Section: Methodsmentioning

confidence: 99%

Matching ICD‐11 personality status to clinical management in a community team—The Boston (UK) Personality Project: Study protocol

Jha

Barrett

Brewin

et al. 2022

Personality & Mental Health

Self Cite

View full text Add to dashboard Cite

Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments.Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.

show abstract

“…There are also some limitations of the trial. In keeping with the approach adopted by other recent trials in the personality disorder field [38,39], we have not included a detailed assessment of personality disorders. This is because such assessments are time-consuming to complete and this is not in keeping with the needs of a pragmatic study that will be conducted in a busy clinical setting.…”

Section: Discussionmentioning

confidence: 99%

A feasibility randomised controlled trial with an embedded qualitative evaluation of perinatal emotional skills groups for women with borderline personality disorder: protocol for the EASE study

Moran

Bick

Biddle

et al. 2022

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

Background Borderline personality disorder (BPD) is a severe mental disorder characterised by emotional instability, impaired interpersonal functioning and an increased risk of suicide. There is no clear evidence about how best to help women with BPD during the perinatal period. Perinatal Emotional Skills Groups (ESGs) consist of 12 group sessions, focussing on core skills in emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness and how these skills can best be utilised during the perinatal period. Prior observational research has shown that perinatal ESGs may help women with BPD. We set out to test the feasibility of conducting a randomised controlled trial to investigate the clinical effectiveness of perinatal ESGs. Methods A two-arm, parallel-group, feasibility randomised controlled trial of Perinatal ESGs in addition to Treatment as Usual (TAU) versus TAU for women aged over 18 years, who are likely to have a diagnosis of BPD and are either pregnant or are within 12 months of having a live birth. We will exclude women who have a co-existing organic, psychotic mental disorder or substance use dependence syndrome; those with cognitive or language difficulties that would preclude them from consenting or participating in study procedures; those judged to pose an acute risk to their baby and those requiring admission to a mother and baby unit. After consenting to participation and completing screening assessments, eligible individuals will be randomly allocated, on a 1:1 ratio, to either ESGs + TAU or to TAU. Randomisation will be stratified according to recruitment centre. Feasibility outcomes will be the proportion of participants: (1) consenting; (2) completing baseline measures and randomised; (3) completing the intervention and (4) completing follow-up assessments. All study participants will complete a battery of self-report measures at 2 and 4 months post-randomisation. A nested qualitative study will examine participants’ and therapists’ experiences of the trial and the intervention. Discussion Evidence is lacking about how to help women with BPD during the perinatal period. Perinatal ESGs are a promising intervention and if they prove to be an effective adjunct to usual care, a large population of vulnerable women and their children could experience substantial health gains. Trial registration ISRCTN80470632.

show abstract

Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention

Cited by 11 publications

References 37 publications

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Matching ICD‐11 personality status to clinical management in a community team—The Boston (UK) Personality Project: Study protocol

A feasibility randomised controlled trial with an embedded qualitative evaluation of perinatal emotional skills groups for women with borderline personality disorder: protocol for the EASE study

Contact Info

Product

Resources

About