Effects of mindfulness training on different components of impulsivity in borderline personality disorder

Title

Effects of mindfulness training on different components of impulsivity in borderline personality disorder

Author

Jimmy Petruzzi

jimmy petruzzi

Selected articles for comparison

Elices, M., Soler, J., Feliu-Soler, A., Carmona, C., Tiana, T., Pascual, J. C., … Álvarez, E. (2017). Combining emotion regulation and mindfulness skills for preventing depression relapse: a randomized-controlled study. Borderline Personality Disorder and Emotion Dysregulation, 4, 13. http://doi.org/10.1186/s40479-017-0064-6

Soler J, Valdepérez A, Feliu-Soler A, Pascual JC, Portella MJ, Martín-Blanco A, et al. Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behav Res Ther. 2012;50:150–7

Methodology

Elices, M., Soler, J., Feliu-Soler, A., Carmona, C., Tiana, T., Pascual, J. C., … Álvarez, E. (2017) conducted a pilot study the application of mindfulness with patients who had a diagnosis of BPD, the study took into consideration that mindfulness  training could assist in the modification of facets of impulsivity in patients with BPD. The method for the research  was  64 subjects with BPD diagnosis were  Subjected to 10 weeks of mindfulness training, with all participants being assessed pre and post intervention measuring impulsivity and neuropsychological tasks comparing the effects of MT and IE on borderline symptons with research randomization software to ensure reliability and validity.Interviews were conducted by skilled professionals with out prior knowledge of participants who were separated in groups of 8, the patients were recruited from a out patient psychiatry unit and of 92 screened participants 64 were randomised 32 to each treatment protocol, patients were selected with a strict quality control procedure

 

According to Behaviour Research and Therapy Soler J, Valdepérez A, Feliu-Soler A, Pascual JC, Portella MJ, Martín-Blanco A, Alvarez E, Pérez V Behav Res Ther. 2012 Feb; 50(2):150-7  there have been measurable improvements in patients with BPD utilising mindfulness in adverse to controlled interventions measured by the  (CPT-II)

this study was conducted with patients receiving treatment along side psychiatric treatment 60 patients we recruited for this study all of them having BPD, 40 of the patients received  DBT Mindfulness and Psychiatric treatment and 20 psychiatric treatment alone,based on the CPT-II neuropsychological test the more participation of mindfulness the more improvement of psychiatric symptons , in order to be recruited the patients had to meet a BPD diagnostic criteria and recruitment was from a psychiatric hospital , the interviews consisted of two semi structured interviews , the interviews and evaluations were conducted by experienced psychologists and psychiatrists , the main variable  assessed by CPT-II, psychopathological symptom’s assessed pre and post interventions using  HRSD-17, BPRS and  POMS; mindfulness questionnaire’s were given to the patients pre and post intervention  FFMQ and (EQ,

One of the themes of DBT is utilising psycho education, teaching and making patients aware of their condition. Mindfulness is a central part of DBT, cultivating an attitude of acceptance, not resignation, though acceptance, the situation is as it is, or the feeling, then taking responsibility to change. As it stands DBT is the treatment with the most empirical evidence for Border line Personality Disorder. Due to the high impulsivity of patients with BPD utilising mindfulness could potentially help the patients become more aware and not react as impulsive.

According to the results of the following study  Jessica R. Peters, Shannon M. Erisman, Brian T. Upton, Ruth A. Baer, Lizabeth Roemer. (2011): 228-235.Mindfulness has the potential to help with impulsivity and maladaptive behaviour due to impulsivity and aspect of patients with BPD is impulsivity.

 

I think the study provided some interesting findings and has the potential to be further developed, the researchers took into consideration whether some of the patient had exposure to mindfulness skills before, they also took into consideration which set of skills the patients had exposure to first and how that would correlate to DBT skills training, that said a core component of DBT is mindfulness and it is likely that patients with DBT will have had exposure to mindfulness skills prior to the participation. I think one of the biggest challenges is to construct a reliable model for testing impulsivity in BPD, it appears the researchers did extremely well  to  construct a multi model of assessment and in contrast to a former study of the group  Soler J, Valdepérez A, Feliu-Soler A, Pascual JC, Portella MJ, Martín-Blanco A, Alvarez E, Pérez V Behav Res Ther. 2012 Feb; 50(2):150-7

The improvement ratio differed in the areas of inhibition, the authors point out that might have been due to other variable factors such as the  co-morbidities differential’s between bulimia nervosa ADHD , the authors explain this is why the response  delay of gratification was improved and response inhibition. Though it is important to note ADHD was not directly assesses and going off the   CPT-II only a relative small proportion of the group 14 percent had 70 percent ADHD symptomology, I think it is important that future studies do incorporate variable BPD profiles which factor in the co-morbidities ratios and in the way the MT is applied

  1. Giluk, (2009)has demonstrated correlations between mindfulness and the impulsive aspect of DBT, though to date there is not much evidence to support mindfulness interventions on impulsivity related to BPD. I think one of the challenges of both studies would be the spectrum of low attention deficit in patients with DBT and the ability to partake and sustain a program of mindfulness which has a core base of awareness and being present.

Lars Schulze,(2016) conducted a study from a biological perspective of patients from BPD , pooling data from 19 published studies, and they reported structural differences in the Amygdala and pre frontal cortex, these are important findings because, it would suggest that depending on the severity and spectrum of biologically differences each person is going to respond in a different way. Hence I believe it is a challenge to monitor the effects of mindfulness on patients diagnosed with DBT,

Though I think with the benefit of technology, if a study could be conducted to assess structural changes to the brain, this may be a more accurate way to monitor improvements from treatment.

 

 

 

References

Elices, M., Soler, J., Feliu-Soler, A., Carmona, C., Tiana, T., Pascual, J. C., … Álvarez, E. (2017). Combining emotion regulation and mindfulness skills for preventing depression relapse: a randomized-controlled study. Borderline Personality Disorder and Emotion Dysregulation, 4, 13. http://doi.org/10.1186/s40479-017-0064-6

Jessica R. Peters, Shannon M. Erisman, Brian T. Upton, Ruth A. Baer, Lizabeth Roemer. (2011) A Preliminary Investigation of the Relationships Between Dispositional Mindfulness and Impulsivity. Mindfulness 2:4, 228-235.

Lars Schulze, Christian Schmahl, Inga Niedtfeld. Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis. Biological Psychiatry, 2016; 79 (2): 97 DOI: 10.1016/j.biopsych.2015.03.027

Soler J, Valdepérez A, Feliu-Soler A, Pascual JC, Portella MJ, Martín-Blanco A, et al. Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behav Res Ther. 2012;50:150–7

 

Tamara L. Giluk , Personality and Individual Differences. Mindfulness, Big Five personality, and affect: A meta-analysis  Dec 2009, Vol. 47, No. 8: 805-811