Outside Research on DBT and BPD — April 2015

1.   Clas­si­cal con­di­tion­ing in bor­der­line per­son­al­ity dis­or­der: an fMRI study
A Krause-Utz, J Keibel-Mauchnik, U Ebner-Priemer… — Euro­pean Archives of …, 2015
Pre­vi­ous research sug­gests dis­turbed emo­tional learn­ing and mem­ory in bor­der­line per­son­al­ity dis­or­der (BPD). Stud­ies inves­ti­gat­ing the neural cor­re­lates of aver­sive dif­fer­en­tial delay con­di­tion­ing in BPD are cur­rently lack­ing. We aimed to inves­ti­gate acqui­si­tion, within-session extinc­tion, between-session extinc­tion recall, and reac­qui­si­tion. We expected increased acti­va­tion in the insula, amyg­dala, and ante­rior cin­gu­late, and decreased pre­frontal acti­va­tion in BPD patients. Dur­ing func­tional mag­netic res­o­nance imag­ing, 27 medication-free female BPD patients and 26 female healthy con­trols (HC) per­formed a dif­fer­en­tial delay aver­sive con­di­tion­ing par­a­digm. An elec­tric shock served as uncon­di­tioned stim­u­lus, two neu­tral pic­tures as con­di­tioned stim­uli (CS+/CS−). Depen­dent vari­ables were blood-oxygen-level-dependent response, skin con­duc­tance response (SCR), and sub­jec­tive rat­ings (valence, arousal). No sig­nif­i­cant between-group dif­fer­ences in brain acti­va­tion were found [all p(FDR) > 0.05]. Within-group com­par­isons for CS+unpaired > CS− revealed increased insula activ­ity in BPD patients but not in HC dur­ing early acqui­si­tion; dur­ing late acqui­si­tion, both groups recruited fronto-parietal areas [p(FDR) < 0.05]. Dur­ing extinc­tion, BPD patients rated both CS+ and CS− as sig­nif­i­cantly more arous­ing and aver­sive than HC and acti­vated the amyg­dala in response to CS+. In con­trast, HC showed increased pre­frontal activ­ity in response to CS+ > CS dur­ing extinc­tion. Dur­ing extinc­tion recall, there was a trend for stronger SCR to CS+ > CS in BPD patients. Amyg­dala habit­u­a­tion to CS+paired (CS+ in tem­po­ral con­tin­gency with the aver­sive event) dur­ing acqui­si­tion was found in HC but not in patients. Our find­ings sug­gest altered tem­po­ral response pat­terns in terms of increased vig­i­lance already dur­ing early acqui­si­tion and delayed extinc­tion processes in indi­vid­u­als with BPD.

2.   Adult attach­ment and emo­tion dys­reg­u­la­tion in bor­der­line per­son­al­ity and somato­form dis­or­ders
A van Dijke, JD Ford — Bor­der­line Per­son­al­ity Dis­or­der and Emo­tion …, 2015
Back­ground: Bor­der­line per­son­al­ity dis­or­der (BPD) and somato­form dis­or­ders (SoD) involve sig­nif­i­cant prob­lems in rela­tion­ships and emo­tion reg­u­la­tion, but the sim­i­lar­i­ties and dif­fer­ences between these dis­or­ders in these areas is not well under­stood.
Method: In 472 psy­chother­apy inpa­tients BPD and/or SoD diag­noses were con­firmed or ruled out using clin­i­cal inter­views and stan­dard­ized mea­sures. Emo­tional under– and over-regulation and indices of adult attach­ment work­ing mod­els and fears were assessed with val­i­dated self-report mea­sures. Bivari­ate and mul­ti­vari­ate analy­ses were con­ducted to exam­ine rela­tion­ships among the study vari­ables and dif­fer­ences based on diag­nos­tic sta­tus.
Results: Under-regulation of emo­tion was mod­er­ately related to fear of aban­don­ment but weakly related to fear of close­ness. Over-regulation of emo­tion was mod­er­ately related to fear of close­ness but not to fear of aban­don­ment. BPD was asso­ci­ated with under-regulation of emo­tion and fear of aban­don­ment, and, when comor­bid with SoD, with fear of close­ness. SoD was asso­ci­ated with inhi­bi­tion or denial of fears of aban­don­ment or close­ness, and over-regulation of emo­tion.
Con­clu­sions: Study results sug­gest that inse­cure attach­ment may play a role in both BPD and SoD, but in dif­fer­ent ways, with hyper­ac­ti­vat­ing emo­tion dys­reg­u­la­tion promi­nent in BPD and deac­ti­vat­ing emo­tion dys­reg­u­la­tion evi­dent in SoD. Also, com­bined hyper– and de-activating strat­egy com­po­nents that may reflect a pat­tern of dis­or­ga­nized attach­ment were found, par­tic­u­larly in patients with comor­bid BPD and SoD.

3.   Rejec­tion sen­si­tiv­ity and symp­tom sever­ity in patients with bor­der­line per­son­al­ity dis­or­der: effects of child­hood mal­treat­ment and self-esteem
M Bungert, L Liebke, J Thome, K Haeus­sler, M Bohus…Personality Dis­or­der and..,2015
Back­ground: Inter­per­sonal dys­func­tion in Bor­der­line Per­son­al­ity Dis­or­der (BPD) is char­ac­ter­ized by an ‘anx­ious pre­oc­cu­pa­tion with real or imag­ined aban­don­ment’ (DSM-5). This symp­tom descrip­tion bears a close resem­blance to that of rejec­tion sen­si­tiv­ity, a cog­ni­tive affec­tive dis­po­si­tion that affects per­cep­tions, emo­tions and behav­ior in the con­text of social rejec­tion. The present study inves­ti­gates the level of rejec­tion sen­si­tiv­ity in acute and remit­ted BPD patients and its rela­tion to BPD symp­tom sever­ity, child­hood mal­treat­ment, and self-esteem.
Meth­ods: Data were obtained from 167 female sub­jects: 77 with acute BPD, 15 with remit­ted BPD, and 75 healthy con­trols who were matched with the patients for age and edu­ca­tion. The instru­ments used for assess­ment were the Rejec­tion Sen­si­tiv­ity Ques­tion­naire, the short ver­sion of the Bor­der­line Symp­tom List, the Child­hood Trauma Ques­tion­naire, and the Rosen­berg Self-Esteem Scale.
Results: Both acute and remit­ted BPD patients had higher scores on the Rejec­tion Sen­si­tiv­ity Ques­tion­naire than did healthy con­trols. Lower self-esteem was found to be pos­i­tively cor­re­lated with both increased BPD symp­tom sever­ity and higher rejec­tion sen­si­tiv­ity, and medi­ated the rela­tion between the two. His­tory of child­hood mal­treat­ment did not cor­re­late with rejec­tion sen­si­tiv­ity, BPD symp­tom sever­ity, or self-esteem.
Con­clu­sions: Our find­ings sup­port the hypoth­e­sis that rejec­tion sen­si­tiv­ity is an impor­tant com­po­nent in BPD, even for remit­ted BPD patients. Level of self-esteem appears to be a rel­e­vant fac­tor in the rela­tion­ship between rejec­tion sen­si­tiv­ity and BPD symp­tom sever­ity. Ther­a­peu­tic inter­ven­tions for BPD would do well to tar­get rejec­tion sensitivity.

4.   Emo­tional hyper­re­ac­tiv­ity in response to child­hood abuse by pri­mary care­givers in patients with bor­der­line per­son­al­ity dis­or­der
J Lobbestael, A Arntz — Jour­nal of Behav­ior Ther­apy and Exper­i­men­tal …, 2015
Back­ground: One of the core pos­tu­lated fea­tures of bor­der­line per­son­al­ity dis­or­der (BPD) is extreme emo­tional reac­tiv­ity to a wide array of evoca­tive stim­uli. Find­ings from pre­vi­ous exper­i­men­tal research how­ever are mixed, and some the­o­ries sug­gest speci­ficity of hyper emo­tional responses, as being related to abuse, rejec­tion and aban­don­ment only.
Objec­tive: The cur­rent exper­i­ment exam­ines the speci­ficity of emo­tional hyper­re­ac­tiv­ity in BPD.
Method: The impact of four film clips (BPD-specific: child­hood abuse by pri­mary care­givers; BPD-nonspecific: peer bul­ly­ing; pos­i­tive; and neu­tral) on self-reported emo­tional affect was assessed in three female groups; BPD-patients (n = 24), clus­ter C per­son­al­ity dis­or­der patients (n = 17) and non-patient con­trols (n = 23).
Results: Results showed that com­pared to the neu­tral film clip, BPD-patients reacted with more over­all neg­a­tive affect fol­low­ing the child­hood abuse clip, and with more anger fol­low­ing the peer bul­ly­ing clip than the two other groups.
Lim­i­ta­tions: The cur­rent study was restricted to assess­ment of the impact of evoca­tive stim­uli on self-reported emo­tions, and the order in which the film clips were pre­sented to the par­tic­i­pants was fixed.
Con­clu­sions: Results sug­gest that BPD-patients only react gen­er­ally exces­sively emo­tional to stim­uli related to child­hood abuse by pri­mary care­givers, and with exces­sive anger to peer-bullying stim­uli. These find­ings are thus not in line with the core idea of gen­eral emo­tional hyper­re­actvity in BPD.

5.   Impul­siv­ity and Non­sui­ci­dal Self-Injury: A Review and Meta-Analysis
CA Hamza, T Willoughby, T Hef­fer — Clin­i­cal Psy­chol­ogy Review, 2015
Non­sui­ci­dal self-injury (NSSI; direct self-injury with­out lethal intent) often is thought to be asso­ci­ated with impulse con­trol prob­lems. Recent research, how­ever, offers con­flict­ing results about whether impul­siv­ity is a risk fac­tor for NSSI engage­ment. To dis­en­tan­gle find­ings on the link between impul­siv­ity and NSSI, an exten­sive review of the lit­er­a­ture was con­ducted using sev­eral elec­tronic data­bases (i.e., Psych­Info, Psy­chAr­ti­cles, ERIC, CINAHL, and MEDLINE). In total, 27 stud­ies that met the spe­cific inclu­sion cri­te­ria were iden­ti­fied. Results of a meta-analysis revealed that indi­vid­u­als who engaged in NSSI self-reported greater impul­siv­ity than indi­vid­u­als who did not engage in NSSI, and that this effect was most con­sis­tent for mea­sures of neg­a­tive urgency. In con­trast, there was lit­tle evi­dence of an asso­ci­a­tion between lab-based mea­sures of impul­siv­ity (e.g., Go/No-Go, Stop/Signal Task) and NSSI. More­over, the link between impul­siv­ity and NSSI found for self-report mea­sures was some­times elim­i­nated when other risk fac­tors for NSSI were con­trolled (e.g., abuse, depres­sion, post-traumatic stress dis­or­der). In addi­tion to inte­grat­ing find­ings, the present review pro­vides sev­eral expla­na­tions for the dis­crep­an­cies in find­ings between stud­ies employ­ing self-report ver­sus lab-based mea­sures of impul­siv­ity. To con­clude, sev­eral spe­cific rec­om­men­da­tions for future research direc­tions to extend the lit­er­a­ture on impul­siv­ity and NSSI are offered.

Announcing the First Intensive Training in the DBT Prolonged Exposure Protocol

We are very excited to announce that we will be hold­ing the first ever inten­sive train­ing in the DBT Pro­longed Expo­sure pro­to­col on March 26–29, 2015 at the Uni­ver­sity of Wash­ing­ton in Seat­tle.  This 4-day work­shop is designed to pro­vide in-depth train­ing in how to inte­grate PTSD treat­ment into stan­dard DBT with high-risk and multi-problem clients.  This is also the first event in a new series of work­shops that will be offered
by the BRTC Exper­i­men­tal Train­ing group to
pro­vide smaller scale, advanced train­ings to DBT clinicians.

You can find detailed infor­ma­tion about the train­ing and sub­mit an appli­ca­tion at: http://depts.washington.edu/brtcdbt/
Space is lim­ited to 40 par­tic­i­pants, so be sure to apply early!

Anita Lungu Wins APA Dissertation Research Award

Con­grat­u­la­tions to doc­toral stu­dent Anita Lungu for her recent selec­tion as a recip­i­ent of the 2014 Amer­i­can Psy­cho­log­i­cal Asso­ci­a­tion Dis­ser­ta­tion Research Award, a pres­ti­gious award with the pur­pose of assist­ing science-oriented doc­toral stu­dents of psy­chol­ogy with research costs asso­ci­ated with their dis­ser­ta­tion research.

DBT Launches in Ireland

Dialec­ti­cal Behav­ior Ther­apy has had a pro­found impact on pop­u­la­tions in the Cork region of Ire­land since its imple­men­ta­tion there in 2010, and the ther­apy is now spread­ing across the coun­try as a suc­cess­ful treat­ment for sui­ci­dal and self-harming behav­iors. Read more

Marsha Linehan wins James McKeen Cattell Award

Con­grat­u­la­tions to Mar­sha!  She is the 2014 recip­i­ent of the  Asso­ci­a­tion for Psy­cho­log­i­cal Sci­ence (APS) James McK­een Cat­tell Award. The APS James McK­een Cat­tell Fel­low Award rec­og­nizes APS Mem­bers for a life­time of out­stand­ing con­tri­bu­tions to the area of applied psy­cho­log­i­cal research. Recip­i­ents must be APS Mem­bers whose research addresses a crit­i­cal prob­lem in soci­ety at large.

Anita Lungu wins SSCP award

Con­grat­u­la­tions to Anita Lungu for receiv­ing the pres­ti­gious Soci­ety for a Sci­ence of Clin­i­cal Psy­chol­ogy (SSCP) Dis­ser­ta­tion Grant Award for her study: Com­put­er­ized Trans-Diagnostic DBT Skills Train­ing for Emo­tion Dys­reg­u­la­tion. The award is intended to both rec­og­nize and sup­port stu­dents who are work­ing on their dis­ser­ta­tion in the field of clin­i­cal psychology.

Honor student, Kay Chai, wins award and scholarship

Honor stu­dent, Kay Yu Yuan Chai, won the 2013 Guthrie Prize in the Best Research Pro­posal cat­e­gory for her paper“The Pre­lim­i­nary Effi­cacy, Fea­si­bil­ity and Accept­abil­ity of a Brief Audio-Guided Dialec­ti­cal Behav­ior Ther­apy Mind­ful­ness Skills Inter­ven­tion for Col­lege Stu­dents with Emo­tional Dysregulation,”

Kay also was awarded the Mary Gates Research Schol­ar­ship for her work in DBT and Mind­ful­ness Skills. This pres­ti­gious and com­pet­i­tive schol­ar­ship pro­vides fund­ing for two quar­ters of under­grad­u­ate research to UW stu­dents who are con­duct­ing inno­v­a­tive research in their field.

Kay’s men­tors are Marivi Navarro, Ph.D., and Mar­sha Line­han, Ph.D.