Changes in adolescents with borderline personality features and caregivers after dialectical behaviour multifamily group therapy

  1. Sara Marco 1
  2. María Mayoral 2
  3. Gonzalo Hervás 3
  1. 1 Sant Joan de Déu Terres de Lleida Hospital, Spain
  2. 2 Hospital General Universitario Gregorio Marañón, Madrid, Spain
  3. 3 Complutense University of Madrid, Spain
Mostrar afiliaciones +
Revista:
Revista de Psicología Clínica con Niños y Adolescentes

ISSN: 2340-8340

Año de publicación: 2024

Volumen: 11

Número: 1

Tipo: Artículo

DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Otras publicaciones en: Revista de Psicología Clínica con Niños y Adolescentes

Resumen

Cambios en adolescentes con rasgos de trastorno límite de personalidad y cuidadores tras un grupo multifamiliar de terapia dialéctico conductual. La Terapia Dialéctico Conductual (TDC) es efectiva para el tratamiento de los síntomas del Trastorno Límite de Personalidad (TLP) y ha sido adaptada a población adolescente (TDC-A). El objetivo de este estudio piloto fue determinar si el grupo de habilidades de TDC-A como tratamiento independiente podría mejorar los estilos de crianza y la regulación emocional en adolescentes con características de TLP y sus padres. Diseñamos una intervención grupal de habilidades de 12 semanas de duración con 14 adolescentes con características de TLP y sus cuidadores. Los partici-pantes (81.82% mujeres) tenían edades desde 14 a 17 años (M= 15.55 SD= .82).Evaluamos los resultados de la intervención mediante la prueba no paramétrica de Wilcoxon y el cálculo de los tamaños del efecto. Para conocer los cambios individuales, informamos el cambio clínico significativo (CCS). También se evaluó la aceptabilidad de la intervención. La intervención fue efectiva para mejorar los estilos de crianza (más afectivo y menos crítico) en padres y adolescentes. Los cambios en los procesos de regulación emocional fueron mixtos. Algunos de los cambios se mantuvieron estables 6 meses después de la intervención. Los participantes reportaron buenos niveles de satisfacción con la intervención. Una intervención multifamiliar grupal de TDC-A podría modificar los potenciales mecanismos relacionados con el desarrollo del TLP como son los estilos de crianza. La intervención podría no ser suficiente para mejorar los procesos de regulación emocional. Desarrollar una intervención temprana con adolescentes con rasgos de TLP podría modificar los mecanismos que previenen el establecimiento de TLP.

Referencias bibliográficas

  • Asarnow, J. R., Berk, M. S., Bedics, J., Adrian, M., Gallop, R., Cohen, J., Korslund, K., Hughes, J., Avina, C., Linehan, M. M., & McCauley, E. (2021). Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators. Journal of the American Academy of Child and Adolescent Psychiatry, 60(9), 1105–1115.e4. https:// doi.org/10.1016/j.jaac.2021.01.016
  • Berk, M. S., Starace, N. K., Black, V. P., & Avina, C. (2020). Implementation of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents in a Community Clinic. Archives of suicide research: official journal of the International Academy for Suicide Research, 24(1), 64–81. https://doi.org/1 0.1080/13811118.2018.1509750
  • Blackford, J. U., & Love, R. (2011). Dialectical behavior therapy group skills training in a community mental health setting: a pilot study. International Journal of Group Psychotherapy, 61(4), 645–657. https://doi.org/10.1521/ ijgp.2011.61.4.645
  • Buckholdt, K. E., Parra, G. R., & Jobe-Shields, L. (2010). Emotion dysregulation as a mechanism through which parental magnification of sadness increases risk for binge eating and limited control of eating behaviors. Eating Behaviors, 11(2), 122–126. https://doi.org/10.1016/j.eatbeh.2009.10.003
  • Chen, S. Y., Cheng, Y., Zhao, W. W., & Zhang, Y. H. (2021). Effects of dialectical behaviour therapy on reducing self-harming behaviours and negative emotions in patients with borderline personality disorder: A meta-analysis. Journal of Psychiatric and Mental Health Nursing, 28(6), 1128–1139. https://doi.org/10.1111/jpm.12797
  • Cheung, R. Y. M., Chan, L. Y., & Chung, K. K. H. (2020). Emotion dysregulation between mothers, fathers, and adolescents: Implications for adolescents’ internalizing problems. Journal of Adolescence, 83, 62–71. https:// doi.org/10.1016/j.adolescence.2020.07.001
  • Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence. Child and Adolescent Mental Health, 21(2), 81–89. https://doi. org/10.1111/camh.12112
  • Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017). Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA psychiatry, 74(4), 319–328. https://doi.org/10.1001/jamapsychiatry.2016.4287
  • Cuevas-Yust, C., & López-Pérez, G. (2012). Intervenciones psicológicas eficaces para el tratamiento del trastorno límite de la personalidad. International Journal of Psychology and Psychological Therapy, 12, 97-114.
  • Cui, L., Zhang, X., & Han, Z. R. (2021). Perceived Child Difficultness, Emotion Dysregulation, and Emotion-Related Parenting among Chinese Parents. Family Process, 60(4), 1403–1417. https://doi.org/10.1111/famp.12638
  • Dibaj, I. S., Tørmoen, A. J., Klungsøyr, O., Haga, E. & Mehlum, L. (2023). Trajectories and Predictors of Change in Emotion Dysregulation and Deliberate Self-Harm Amongst Adolescents with Borderline Features. Clinical child psychology and psychiatry, 13591045231177374. Advance online publication. https://doi.org/10.1177/13591045231177374.
  • Ekdahl, S., Idvall, E., & Perseius, K. I. (2014). Family skills training in dialectical behaviour therapy: the experience of the significant others. Archives of Psychiatric Nursing, 28(4), 235–241. https://doi.org/10.1016/j.apnu.2014.03 2
  • Feldman, G., Harley, R., Kerrigan, M., Jacobo, M., & Fava, M. (2009). Change in emotional processing during a dialectical behavior therapy-based skills group for major depressive disorder. Behaviour Research and Therapy, 47(4), 316–321. https://doi.org/10.1016/j.brat.2009.01 5
  • Fischer, S., & Peterson, C. (2015). Dialectical behavior therapy for adolescent binge eating, purging, suicidal behavior, and non-suicidal self-injury: a pilot study. Psychotherapy, 52(1), 78–92. https://doi.org/10.1037/a0036065
  • Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up. Child and Adolescent Psychiatry and Mental Health, 5(1), 3. https://doi.org/10.1186/1753-2000-5-3
  • Flynn, D., Kells, M., Joyce, M., Corcoran, P., Gillespie, C., Suarez, C., Swales, M., & Arensman, E. (2019). Innovations in Practice: Dialectical behaviour therapy for adolescents: multisite implementation and evaluation of a 16-week programme in a public community mental health setting. Child and Adolescent Mental Health, 24(1), 76–83. https://doi.org/10.1111/camh.12298
  • Fuentes, M. J., Motrico, E., & Bersabé, R.M. (1999). Escala de Afecto (EA) y Escala de Normas y Exigencias (ENE): versión hijos y versión padres. Universidad de Málaga.
  • Gasol, X., Navarro-Haro, M. V., Fernández-Felipe, I., García-Palacios, A., Suso-Ribera, C., & Gasol-Colomina, M. (2022). Preventing Emotional Dysregulation: Acceptability and Preliminary Effectiveness of a DBT Skills Training Program for Adolescents in the Spanish School System. International Journal of Environmental Research and Public Health, 19(1), 494. https://doi.org/10.3390/ijerph19010494
  • Gratz, K. L., Bardeen, J. R., Levy, R., Dixon-Gordon, K. L., & Tull, M. T. (2015). Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Behaviour Research and Therapy, 65, 29–35. https://doi.org/10.1016/j.brat.2014.12.005
  • Groves, S., Backer, H. S., Van den Bosch, W., & Miller, A. (2012). Review: Dialectical behaviour therapy with adolescents. Child and Adolescent Mental Health, 17(2),: 65–75. https://doi.org/10.1111/j.1475-3588.2011 611.x
  • Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of Nervous and Mental Disease, 196(2), 136–143. https://doi.org/10.1097/NMD.0b013e318162aa3f
  • Hervas, G. & Jódar, R. (2008). Adaptación al castellano de la Escala de Dificultades en la Regulación Emocional. Clínica y Salud, 19(2), 139-156.
  • Hoffman, P. D., Fruzzetti, A. E., & Swenson, C. R. (1999). Dialectical behavior therapy-family skills training. Family Process, 38(4), 399–414. https://doi. org/10.1111/j.1545-5300.1999 399.x
  • Hoffman, P. D., Fruzzetti, A. E., Buteau, E., Neiditch, E. R., Penney, D., Bruce, M. L., Hellman, F., & Struening, E. (2005). Family connections: a program for relatives of persons with borderline personality disorder. Family Process, 44(2), 217–225. https://doi.org/10.1111/j.1545-5300.2005.00055.x
  • Hollenbaugh, K., & Lenz, A. (2018). Preliminary Evidence for the Effectiveness of Dialectical Behavior Therapy for Adolescents. Journal of Counseling and Development. 96, 119-131. https://doi.org/10.1002/jcad.12186.
  • Holmqvist Larsson, K., Andersson, G., Stern, H., & Zetterqvist, M. (2020). Emotion regulation group skills training for adolescents and parents: A pilot study of an add-on treatment in a clinical setting. Clinical Child Psychology and Psychiatry, 25(1), 141–155. https://doi. org/10.1177/1359104519869782
  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi. org/10.1037//0022-006x.59.1.12
  • Jørgensen, M. S., Storebø, O. J., Poulsen, S., & Simonsen, E. (2021). Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder. Family process, 60(3), 772–787. https://doi. org/10.1111/famp.12593
  • Klein, D. A., & Miller, A. L. (2011). Dialectical behavior therapy for suicidal adolescents with borderline personality disorder. Child and Adolescent Psychiatric Clinics of North America, 20(2), 205–216. https://doi.org/10.1016/j. chc.2011.01 1
  • Kramer, U., Grandjean, L., Beuchat, H., Kolly, S., Conus, P., de Roten, Y., Draganski, B., & Despland, J. N. (2020). Mechanisms of change in brief treatments for borderline personality disorder: a protocol of a randomized controlled trial. Trials, 21(1), 335. https://doi.org/10.1186/s13063-020-4229-z
  • Koerner, K. (2013). What must you know and do to get good outcomes with DBT? Behavior Therapy, 44(4), 568–579. https://doi.org/10.1016/j. beth.2013.03 5
  • Lang, C. M., Edwards, A. J., Mittler, M. A., & Bonavitacola, L. (2018). Dialectical Behavior Therapy With Prolonged Exposure for Adolescents: Rationale and Review of the Research. Cognitive and Behavioral Practice, 25, (3); 416-426. https://doi.org/10.1016/j.cbpra.2017.12 5.
  • Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder (1a Ed.). The Guilford Press.
  • Lynch, T. R, Chapman, A.L., Rosenthal, M.Z., Kuo, J.R., & Linehan M. M. (2006). Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations. Journal of Clinical Psychology; 62, 459 – 80.
  • MacPherson, H.A., Cheavens, J.S., & Fristad, M.A. (2013). Dialectical behavior therapy for adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical Child and Family Psychology Review, 16, 59–80. http:// dx.doi.org/10.1007/s10567-012-0126-7
  • Marco, S., Mayoral, M., & Hervás, G. (2023). Dialectical Behavioral Skills Group Therapy for Parents of Adolescents With Borderline Personality Disorder: A Pilot Study. Clinical Child Psychology and Psychiatry, 13591045231177329. Advance online publication. https://doi.org/10.1177/13591045231177329
  • Martinez-Arias, R., Castellanos-López, M. A., & Chacon-Gomez, J. C. (2015). Análisis de datos en psicología y ciencias de la salud. Volumen II: Inferencia estadística. Editorial EOS.
  • Mayoral, M., Valencia, F., Calvo, A., Roldan, L., Espliego, A., Rodriguez-Toscano, E., Kehrmann, L., Arango, C., & Delgado, C. (2020). Development of an early intervention programme for adolescents with emotion dysregulation and their families: Actions for the treatment of adolescent personality (ATraPA). Early Intervention in Psychiatry, 14(5), 619–624. https://doi. org/10.1111/eip.12934
  • McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., et al. (2018). Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA psychiatry, 75(8), 777–785. https://doi.org/10.1001/jamapsychiatry.2018.1109
  • Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., Larsson, B. S., Stanley, B. H., Miller, A. L., Sund, A. M., & Grøholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(10), 1082–1091. https:// doi.org/10.1016/j.jaac.2014.07.003
  • Mehlum, L., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., Miller, A. L., Sund, A. M., & Grøholt, B. (2016). Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a OneYear Follow-Up. Journal of the American Academy of Child and Adolescent Psychiatry, 55(4), 295- 300. https://doi.org/10.1016/j.jaac.2016.01.005
  • Mehlum, L., Ramleth, R. K., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., Miller, A. L., Larsson, B., Sund, A. M., & Grøholt, B. (2019). Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60(10), 1112–1122. https://doi.org/10.1111/jcpp.13077
  • Miller A. L. (1999). Dialectical behavior therapy: a new treatment approach for suicidal adolescents. American Journal of Psychotherapy, 53(3), 413–417. https://doi.org/10.1176/appi.psychotherapy.1999.53.3.413
  • Miller, A. L., Glinski J., Woodberry, K., Mitchell, A. G., & Indik, J. (2002). Family therapy and dialectical behavior therapy with adolescents: Proposing a clinical synthesis. American Journal of Psychotherapy, 56, 568-584. https:// doi.org/10.1176/appi.psychotherapy.2002.56.4.568
  • Miller, A. L., Rathus, J.H., & Linehan, M. M. (2006). Dialectical behavior therapy with suicidal adolescents. The Guilford Press.
  • Miller, M.L., & Skerven, K. (2017). Family Skills: A Naturalistic Pilot Study of a Family-Oriented Dialectical Behavior Therapy Program. Couple and Family Psychology: Research and Practice, 6, 79–93.
  • Morelen, D., Shaffer, A., & Suveg, C. (2016). Maternal Emotion Regulation: Links to Emotion Parenting and Child Emotion Regulation. Journal of Family Issues, 37(13), 1891–1916. https://doi.org/10.1177/0192513X14546720
  • Navarro-Haro, M. V., Mozota-Chaudrón, P., & García-Palacios, A. (2023). Revisión de revisiones sobre la eficacia de los tratamientos psicológicos para adolescentes con trastorno de la personalidad límite. Revista de Psicología Clínica Con Niños y Adolescentes, 10, 91-98. https://doi. org/10.21134/rpcna.2023.10.8.
  • Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832–839. https://doi.org/10.1016/j.brat.2010.05.017
  • Nelson-Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., et al. (2006). A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings. Behaviour Research and Therapy, 44(12), 1811–1820. https://doi.org/10.1016/j.brat.2006.01 4
  • Pallant, J. (2007). SPSS survival manual. A step by step guide to data analysis using SPSS for windows (3rd ed.). Open University Press.
  • Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). Research on Social Work Practice, 24(2), 213–223. https://doi. org/10.1177/1049731513503047
  • Rajalin, M., Wickholm-Pethrus, L., Hursti, T., & Jokinen, J. (2009). Dialectical behavior therapy-based skills training for family members of suicide attempters. Archives of Suicide Research, 13(3), 257–263. https://doi. org/10.1080/13811110903044401
  • Rathus J. H., & Miller A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and LifeThreatening Behaviors, 32,146-157. https://doi.org/10.1521/suli.32.2.146.24399
  • Rathus, J. H., & Miller, A. L. (2015). DBT Skills Training for Adolescents. The Guilford Press.
  • Roberts, R. E., Attkinsson, C. C., & Mendias, R. M. (1984) Assessing the client satisfaction questionnaire in English and Spanish. Hispanic Journal of Behavioral Sciences, 6(4), 385-95. https://doi.org/10.1177/07399863840064004
  • Rudge, S., Feigenbaum, J. D., & Fonagy, P. (2020). Mechanisms of change in dialectical behaviour therapy and cognitive behaviour therapy for borderline personality disorder: a critical review of the literature. Journal of Mental Health 29(1), 92–102. https://doi.org/10.1080/09638237.2017.1322185
  • Salbach-Andrae, H., Bohnekamp, I., Pfeiffer, E., Lehmkuhl, U., & Miller, A. L. (2008). Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents: A case series. Cognitive and Behavioral Practice, 15, 415–425. https://doi.org/10.1016/j.cbpra.2008.04.001
  • Salbach-Andrae, H., Bürger, A., Klinkowski, N., Lenz, K., Pfeiffer, E., Fydrich, T., & Lehmkuhl, U. (2008). Diagnostik von Persönlichkeitsstörungen im Jugendalter nach SKID-II [Diagnostic of personality disorders in adolescence according to SCID-II]. Zeitschrift fur Kinderund Jugendpsychiatrie und Psychotherapie, 36(2), 117–125. https://doi.org/10.1024/1422- 4917.36.2.117
  • Santamarina-Perez, P., Mendez, I., Singh, M. K., Berk, M., Picado, M., Font, E., Moreno, E., Martínez, E., Morer, A., Borràs, R., Cosi, A., & Romero, S. (2020). Adapted Dialectical Behavior Therapy for Adolescents with a High Risk of Suicide in a Community Clinic: A Pragmatic Randomized Controlled Trial. Suicide & life-threatening behavior, 50(3), 652–667. https:// doi.org/10.1111/sltb.12612
  • Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., Gich, I., Alvarez, E., & Pérez, V. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47(5), 353–358. https://doi.org/10.1016/j.brat.2009.01.013
  • Tørmoen, A. J., Grøholt, B., Haga, E., Brager-Larsen, A., Miller, A., Walby, F., Stanley, B., & Mehlum, L. (2014). Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence, and retention. Archives of suicide research: official journal of the International Academy for Suicide Research, 18(4), 432–444. https:// doi.org/10.1080/13811118.2013.826156
  • Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015). The use of dialectical behavior therapy skills training as stand-alone treatment: a systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71(1), 1–20. https://doi.org/10.1002/jclp.22114
  • Woodberry, K. A., & Popenoe, E. J. (2008). Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cognitive and Behavioral Practice, 15, 277–286. https://doi. org/10.1016/j.cbpra.2007.08.004
  • Zahra, D., & Hedge, C. (2010). The Reliable Change Index: Why Isn’t It More Popular in Academic Psychology? The Psychologist Quarterly, 76, 14-19.
  • Zalewski, M., Lewis, J. K., & Martin, C. G. (2018). Identifying novel applications of dialectical behavior therapy: considering emotion regulation and parenting. Current Opinion in Psychology, 21, 122–126. https://doi. org/10.1016/j.copsyc.2018.02.013
Fuente de los datos: Dialnet