Search results

Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery.

In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles.

As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders.

This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes.

The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

This paper seeks to discuss the need and scope for application of psychological therapeutic techniques in work with problems of chaotic or dysfunctional behaviour, as found among users of homelessness resettlement services.

The paper summarises recent research and UK policy guidance on the mental health needs encountered by frontline homelessness service resettlement staff on a daily basis. It goes on to discuss the impact of these experiences, and the value of training to help staff manage such encounters with greater awareness and skills. In particular, the paper considers the ethical dimension for staff, in responding to users' histories of emotional distress.

There is a relative dearth of studies providing evidence on stress and burn‐out amongst resettlement staff, compared to healthcare staff; nevertheless they face the same or similar pressures in their day‐to‐day work with clients. When asked to consider psychological techniques, some staff may initially fear being expected to be a psychotherapist; but research from clinical practice and recent training workshop experience suggest that training, especially where complemented by supervision or reflective practice, leaves staff feeling more confident.

The application of formal psychological thinking in homelessness resettlement is a relatively new field. This is the first paper to explore issues arising from the perspective of the ethical dilemmas faced by frontline staff in the work of relating to clients' distressed or distressing experiences.

This study aims to evaluate the clinical effectiveness of the Mindfulness module of the “I Can Feel Good” programme, an adapted dialectical behaviour therapy (DBT) informed skills programme for a group of intellectually disabled offenders (IDOs).

The programme module was delivered to a group of five male IDOs detained under the Mental Health Act 1983 (Revised 2007) at an intellectual disability (ID) rehabilitation hospital based in the UK. The mindfulness module was 12 sessions in length, and it was evaluated using the emotional problems scale (EPS) and the cognitive and affective mindfulness scale-revised (CAMS-R) self-assessment and observational scale. These measures were administered pre- and post-module and used the staff report scales as a primary source of evaluation.

Non-parametric testing revealed that there was a reduction in scores post module on the externalising behaviour problem scale of the EPS and increased scores on the CAMS-R observational scale, which would indicate clinical improvement in the IDO’s behavioural presentation, although it was not statistically significant. The internalising behaviour problem scale showed increased signs of anxiety post module, this could be related to increased self-awareness. The CAMS-R self-reported measure indicated reduced mindfulness qualities following the module.

The results indicate that following the mindfulness module, there was a reduced level of challenging behaviour displayed by the patients with increased signs of emotional regulation. There was also an observed reduction in symptoms of depression and low self-esteem post module.

This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.

Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.

Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.

This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.

Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.

Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.

This paper aims to evaluate trends in research and clinical practice that may contribute to the limited utility of assessment and treatment modalities designed to capture and address psychopathy. It identifies a lack of consistency between the academic understanding of psychopathy and how the construct is applied in clinical contexts. The authors provide clarity and direction for a more effective application of the psychopathy construct in practical contexts.

This review first examines the etiology of important limitations to psychopathy research and practical application, and proposes the adoption of the most recent empirical conceptualization of the construct into practical contexts. It then evaluates the current functionality of psychopathy in practical contexts. The review ultimately proposes a method for designing intervention practices based on the model used in the development of dialectical behavior therapy (DBT) for borderline personality disorder, which will improve the practical utility of the construct.

The present review provides evidence that a multifaceted and dimensional perspective of psychopathy will improve the practical utility of the construct and help move the field forward. It suggests that considering independent components of the psychopathy construct along a continuous scale, as with DBT, will contribute to improvements in assessments and treatments that target psychopathy.

The current review applies relevant research to a model for developing an intervention modality particularly in forensic or correctional settings where individuals high in psychopathy are often seen. The implications outlined provide a framework that could impact practice and assessment in forensic contexts moving forward.

Previous research has not concisely outlined problems concerning the link between psychopathy research and how the construct is applied in practical settings. Few researchers have proposed plausible solutions that could improve the utility of the construct in such settings.

This chapter differentiates stress from generalized anxiety, discussing the nature and prevalence of each among college students. The chapter then delves into generalized anxiety in detail, covering instruments that measure generalized anxiety, cultural considerations associated with generalized anxiety and the causes, consequences, prevention and treatment of generalized anxiety among college students. The next section of the chapter focuses on social anxiety among college students, similarly addressing its defining characteristics, prevalence, cultural considerations, causes, consequences, prevention and treatment. The final section of the chapter follows a similar structure in discussing posttraumatic stress disorder (PTSD) among college students. Throughout the chapter, attention is devoted to neurotransmitters and brain structures that are involved in anxiety and its treatment through antianxiety medications. Case examples are used to help bring theoretical concepts and research findings to life.

The purpose of this paper is mainly to present a general review of third generation cognitive-behavioural therapies (CBTs), and to debate whether these approaches are applicable to persons with neurodevelopmental disorders (NDD).

Despite the lack of consistent literature focused on this population, the authors have considered the available general literature on the third generation of CBTs and analysed core issues of the processes within the context of intellectual disabilities and Autism spectrum disorder.

The evidence from typical developing population studies and the emerging literature specific to people with NDD is convincing, but there is a need for studies exploring how and when these therapeutic approaches can be applicable. Two behavioural approaches of third generation therapies – acceptance and commitment therapy and mindfulness-based CBT – appear to have the most potential to be adapted for robust intervention for the broad spectrum of persons with NDD.

The number of studies and methodologies applied are a clear limitation and the present paper is only exploratory.

The paper supports clinicians to use the emerging protocols, and to replicate and implement procedures and techniques.

The purpose of this paper is to present the development and evaluation of an original training package for staff members on an awareness of an adapted Dialectical Behaviour Therapy programme, the “I Can Feel Good” programme (Ingamells and Morrissey, 2014) designed for individuals with intellectual disabilities (ID) and problems managing emotions. The quality and effectiveness of the training was assessed and is reported in this paper.

The training was delivered for staff working with individuals with ID in a UK medium-secure psychiatric hospital and was attended by nursing staff. The workshop consisted of six modules: “Introduction to the programme”, “Mindfulness”, “Managing feelings”, “Coping in Crisis”, “People skills” and “Application and summary”. Level of self-reported knowledge, confidence and motivation regarding seven aspects of the training was measured by an evaluation questionnaire completed pre and post training.

The results of this study showed that following the training there was a significant increase in self-reported knowledge, confidence and motivation regarding the seven aspects of the training. When perceptions of staff behaviours are observed, although in the right direction, this change was found not to be significant.

This study highlights the potential for staff training to increase awareness of newly adapted therapeutic programmes for individuals with ID. The staff training may increase their ability and willingness to facilitate the running of such programmes and ability to support learning transfer in group members.

There are a lack of recourses for substance abuse (SA) treatment for forensic clients with intellectual disabilities (ID). Many complexities arise when treating this population, calling for the creation of comprehensive resources which not only address the SA, but also account for the risk and offending issues. The purpose of this paper is to detail a pilot programme which aims to provide treatment for forensic ID clients with substance abuse issues as well as a significant risk of reoffending.

Six participants completed a 27-week SA treatment programme (the Alcohol and Substance Abuse Programme-Intellectual Disability) which incorporated the use of dialectical behavioural therapy (DBT) and the Good Lives Model concepts. Pre- and post-measures aimed to assess readiness for change and confidence in ability to stay clean and sober.

Preliminary findings showed a marked improvement in confidence of the participants’ ability to stay clean and sober in risk-related situations as well as an increase in overall readiness for change.

This research paper addresses a gap in the current forensic ID research and clinical treatment options pertaining to SA, by focussing on supporting forensic ID clients in their recovery journey from SA. Being at the forefront of SA treatment for forensic ID, further research in this domain should attempt to consolidate the findings of this programme.

Abstract This article summarises criteria that can lead to a diagnosis of personality disorder before considering the impact on personality disorder of specific interventions and policy initiatives designed to ensure that services respond to need.