None listed
Conditions
Brief summary
Borderline Personality Disorder (BPD) is a disabling syndrome which is generally associated with a history of severe childhood trauma and/or neglect. The disorder is characterized by intense, distressing and changeable emotions, impulsive self-destructive behaviour and troubled relationships. Around three quarters of the people with this diagnosis engage in deliberate self-harm (such as cutting or burning themselves) and around eight to ten percent suicide. Treatment of the condition is difficult because of stormy relationships with treating staff and staff anxiety about clients’ suicidality and self-harm. Spectrum is a statewide public sector specialist service, which was established to support the treatment of clients with BPD. Since its inception eight years ago, Spectrum has provided consultation and training to staff, and residential treatment for a small number of clients. Spectrum has been examining ways of offering treatment for a larger number of clients. A difficulty has been the need to do this within Spectrum’s current level of resourcing and that of the Area Mental Health services. Group treatment is, in general a particularly cost effective approach, and has the added benefit of providing an opportunity for clients to expand their social networks. Our aim is to develop a group treatment approach for BPD that can eventually be delivered by area clinicians with Spectrum support. Recently a brief outpatient group treatment was trialed in America and found to be very successful in treating the symptoms of BPD. The groups aimed to teach clients ways of managing their troubling emotions in crises so as to reduce impulsive self-destructiveness. The approach used in that study has many similarities to Spectrum’s residential treatment, and to a group outpatient treatment piloted by Spectrum in 2005. The very positive findings of the American study have lent support to our decision to continue testing a similar outpatient group treatment. The project has two phases. In phase one a 12 week series of groups teaching Crisis Skills will be trialed. For some clients this 12 week group treatment (with ongoing individual treatment) will be enough. For those who require more group treatment, additional skills training will be offered in phase two. Phase two will consist of three further series of groups (each lasting 10 weeks), teaching Interpersonal Skills, Emotion Skills and Mindfulness Skills. Clients who enter phase two treatment will thus be provided with the opportunity for approximately a year of group treatment in total (including phases 1 and 2 and short breaks between modules of treatment). Sixty clients will be recruited into phase 1, via referrals from staff from AMHS staff in Eastern Health, Northwest Mental Health and the Werribee-Mercy Networks. All clients will need to have a support person who can assist them in practicing the skills: e.g. an AMHS or Community Health Centre clinician, GP, or private psychiatrist. These clinicians will receive information and support to assist them in their role.Clients will be invited to attend an information session and a screening interview with one of the Spectrum clinicians and a diagnostic interview with a research assistant. Informed consent will be obtained at the screening interview. Half the clients will be randomly allocated to start phase 1 groups immediately, and the remainder to start after three months. When all clients have been offered the phase 1 groups, phase 2 groups will be offered to all clients. In order to evaluate the treatment, and better understand how it works, clients who consent, will be asked to complete questionnaires before the first group of each series, mid-way through each group series, after the last group of each series, and at three month follow up. Phase 1 treatment will be evaluated by comparing the changes in the first 30 clients treated with the 30 clients on the waiting list, and by comparing test results, for all clients before and after phase 1 treatment. Outcomes from the combined phase 1 and phase 2 groups will also be evaluated, and the process of change examined.
Interventions
Phase 1 is a 12 week two hours per week acceptance-based crisis skills training group. Clients have the option of continuing to Phase 2 which consists of an additional 30 weeks of skills training groups covering interpersonal skills, emotion regulation skils and mindfulness skills. The groups are a combination of Acceptance and Commitment Therapy and Dialectical Behaviour Therapy interventions iin the context of Acceptance and Commitment Therapy principles of treatment.
Sponsors
Spectrum
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Referrals will be accepted of clients who meet the following criteria: 1)four or more criteria of BPD; 2)a registered client of an AMHS; 3) has a case manager, or other identified AMHS staff contact person who can arrange an inpatient admission or crisis team visit if required; 4)has a support person who can assist them in practicing the skills: e.g. an AMHS or Community Health Centre clinician, GP, or private psychiatrist; 5)stated willingness to attend regularly for 12 sessions.
Exclusion criteria
1)current positive or negative psychotic symptoms (other than reactive psychotic symptoms associated with borderline personality disorder);2)likely to significantly interfere with the participation of others e.g. violent or threatening;3)intellectual disability, or cognitive impairment severe enough to interfere with participation.
Outcome results
None listed