Psychological Treatments for Personality Disorders

Question 1

Describe the 3 affective criteria in the DSM-IV criteria for borderline personality disorder

Answer 1

Inappropriate sense of anger, chronic feelings of emptiness, affective instability

Question 2

Describe the 2 cognitive criteria in the DSM-IV criteria for borderline personality disorder

Answer 2

Transient paranoid ideation, identity disturbance

Question 3

Describe the 2 behavioural criteria in the DSM-IV criteria for borderline personality disorder

Answer 3

Recurrent suicidal behaviour or threats, impulsively harmful act other than suicidal behaviour

Question 4

Describe the 2 interpersonal criteria in the DSM-IV criteria for borderline personality disorder

Answer 4

Frantic efforts to avoid abandonment, unstable and intense interpersonal relationships

Question 5

State some challenges in delivering psychological treatments for borderline personality disorder

Answer 5

Lack of trust and engagement, affective instability and lack of commitment, unstable relationships and lack of motivation, patient worries about treatment ending

Question 6

Give some advantages of a personality disorder diagnosis

Answer 6

Gives the individual and their family an explanation, enables access to treatment, ensures individual doesn’t receive treatment for something they don’t have (e.g. psychosis)

Question 7

Give some disadvantages of a personality disorder diagnosis

Answer 7

Undermines personal responsibility, creates dependency, diverts limited resources away from others who may need them, suggests there is a ‘right’ personality, stigma

Question 8

Define fundamental attribution error

Answer 8

The tendency for people to place an undue emphasis of internal characteristics to explain someone else’s behaviour in a situation, rather than considering the situation’s external factors

Question 9

Define mentalisation

Answer 9

The act of interpreting the actions of oneself and others as meaningful on the basis of intentional mental states - e.g. needs, desires, and beliefs. This can be unconscious and implicit (mirroring), or conscious and explicit (interpreting)

Question 10

What is contingent mirroring?

Answer 10

When the caregiver accurately matches the infant’s mental state in their internal representation, rather than projecting their own feelings onto the infant

Question 11

What is incongruent mirroring?

Answer 11

When the caregiver’s internal representation of the infant’s mental state does not correspond to the infant’s actual mental state

Question 12

What is unmarked mirroring?

Answer 12

When the caregiver’s internal representation of the infant’s mental state is an externalisation of their own thoughts, rather than representing the infant

Question 13

Describe the effect of inappropriate mirroring on an infant

Answer 13

It can lead to disruption of the infant’s sense of self

Question 14

When is the ability to mentalise disrupted?

Answer 14

Mental illness, when intoxicated, and in states of heightened emotional arousal (e.g. new relationships, close relationships)

Question 15

State the general features of psychological treatment plans for personality disorder

Answer 15

Assessment, creation of boundaries and flexibility, validation, crisis planning, team work, communication

Question 16

What is mentalisation based treatment (MBT)

Answer 16

A modified psychoanalytic psychotherapy focusing on tounter-transference, tolerance of anxiety, and interpretation, promoting mentalisation and living in the present.

Question 17

How long does mentalisation based treatment for personality disorder last?

Answer 17

18 months, with twice weekly sessions that are a mixture of individual and group

Question 18

Describe the basic mentalisation approach advocated in mentalisation based treatment

Answer 18

Stop, look, listen - appraising a situation, highlighting who feels what and appreciating multiple perspectives, and understanding why reactions occur

Question 19

Describe the evidence for mentalisation based treatment (Bateman & Fonagy, 2009)

Answer 19

MBT produces markedly superior outcomes to treatment as usual. It reduces suicide attempts, self-harm, and inpatient care, and improves mental health and social function

Question 20

What is a schema?

Answer 20

How people organise and make sense of their work

Question 21

How can a schema cause maladaptive cognitions?

Answer 21

Maladaptive thoughts develop when an individual’s schema does not fit with a change in context - e.g. dependent cognitions develop when an individuak’s schema makes them feel helpless, and paranoid cognitions develop when a schema makes them see others as a threat (e.g. due to child abuse)

Question 22

Describe schema-focused therapy

Answer 22

A type of modified CBT lasting 18-24 months with twice-weekly sessions aiming to explore schemas and higher-order cognitive processes

Question 23

Describe the evidence for schema focused therapy for borderline personality disorder

Answer 23

3 RCTs have shown it is cost-effective and may be more affective than psychodynamic psychotherapy

Question 24

Name the 3 areas which dialetical behaviour therapy aims to develop

Answer 24

Mindfulness, interpersonal effectiveness (asking for what one needs, saying no, and coping with interpersonal conflict), and distress tolerance

Question 25

Define mindfulness

Answer 25

The capacity to non-judgementally pay attention to the present moment and live in the moment

Question 26

State the 2 key concepts of dialectical behaviour therapy

Answer 26

Validation and dialectics

Question 27

Define dialectics

Answer 27

The inter-related nature of actions and behaviour, acknowledging how hard it can be to change established patterns of behaviour

Question 28

Describe the aims of dialectical behaviour therapy

Answer 28

Teach new skills (e.g. mindfulness, emotion regulation, distress tolerance), reduce distraction and mind-wandering, and enhance motivation

Question 29

Describe the evidence for dialectical behaviour therapy

Answer 29

8 RCTS have shown it causes a marked reduction in self-harm and some reduction in emotional distress - but the largest trial (McMain, 2009) found no difference between DBT and high-quality general psychiatric care

Question 30

State the NICE recommendations for treating borderline personality disorder

Answer 30

Avoid treatments of short-term duration, use an explicit and integrated approach, adapt frequency to needs with twice-weekly sessions considered, for women with BPD and serious self-harm consider DBT

Question 31

Describe the attrition rate of psychological treatment for borderline personality disorder

Answer 31

50% do not engage with treatment, and 30% of those that do drop out before completion

Question 32

Describe problem solving therapy

Answer 32

A 12-session group intervention designed to help participants learn how to process and solve interpersonal problems

Question 33

Describe the results of a study into problem solving therapy for personality disorder

Answer 33

It was halted by the DMEC due to higher rates of suicide in individuals receiving problem solving therapy - although the relative risk of adverse events was not statistically significant

Question 34

Why might problem solving therapy be ineffective for borderline personality disorder?

Answer 34

It is too short an intervention and does not change the patients’ existing schema