Borderline Personality Disorder Clinical Trial
Official title:
Emotional Dysregulation in Para-suicidal Behavior: Effects of Dialectical Behavioral Therapy on Emotional Processing, a Triangulation Approach
This is a naturalistic cohort pre-post study investigating aspects of emotional processing and how possible changes in emotional processing is related to the successful treatment of non-suicidal self-injury and suicidal ideation in a program of Dialectical Behavior Therapy. In addition we wish to identify to what extent the intensity and frequency of non-suicidal self-injury and suicidal ideation is related to difficulty in emotion regulation, as indicated by self-report measures and psychophysiological measures.
This naturalistic pre-port study tests if Dialectical Behavior Therapy (DBT) - an established
therapy addressing emotion regulation and reduction of non-suicidal self-injury and suicidal
ideation - result in increased emotion regulation capacity, indicated by lowered heart rate
variability (HRV) and self-report measures. The study will also test the impact of DBT on
lowered non-suicidal self-injury and suicidal ideation. Standard Clinical symptom scales will
be included in order to control for anxiety, depression, as well as a measure of impulsivity,
which is common co-morbidities.
Since DBT was developed in the 80ies, DBT has gathered increased empirical support as a
treatment that reduce suicidality, para-suicidal behavior, experienced and expressed anger,
and increased social skills. In DBT, emotional dysregulation is assumed to arise from a
combination of biological vulnerability and living in an invalidating environment.
Self-harm and chronic suicidality is considered to be an emotion regulation strategy. In DBT,
the ability to regulate emotions adaptively requires a set of skills; the ability to
experience emotions, the ability to label emotions, and the ability to modulate stimuli that
serve to reactivate negative or positive emotions. In the absence of these skills, or
instances where the individual is hindered from applying them, more maladaptive behavior is
learned and applied. Individuals that engage in non-suicidal self-injury often report greater
emotion dysregulation than those without an non-suicidal self-injury history. Such behavior
can e.g. be self-inflicted harm, cutting, burning, or hitting , and/or suicidal ideation.
Non-suicidal self-injury is viewed as a learned emotion regulation strategy; because such
behavior instantly can decrease the experience of negative affect. Therapies that focus on
increasing adaptive emotion regulations skills have demonstrated reduced non-suicidal
self-injury and suicidal ideation.
The physiological manifestations of emotions rely on an activation of the Autonomic Nervous
System. The individual experience of emotions is reciprocally related to the continuously
changing levels of physiological arousal. The functioning of this system is in turn related
to adapting to environmental demands. A well established measure of Autonomic Nervous
activity is variation in inter-beat-intervals due to respiratory influence on heart rate,
i.e. respiratory sinus arrhythmia, which is predominately a parasympathetic related
innervation of the heart. Hence, HRV is considered a psychophysiological index of emotion
regulation abilities. HRV is considered an index of the nervous system's ability to flexibly
adapt to changing environmental demands and is considered a biological index of emotion
regulation.
We include a matched control sample of healthy controls to complete the battery of
measurements at baseline assessment of emotion regulation functions (pre-intervention
assessments). This will give the opportunity to characterize the group of patients with
non-suicidal self-injury and suicidal ideation included in the current planned study in
relation to previous research findings of the same functions in samples of patients with
non-suicidal self-injury and suicidal ideation. The combination of clinical, cognitive and
psychophysiological measures is a unique feature of this study, and will provide new
information regarding the mechanisms underpinning clinical change following DBT, and possibly
validate heart rate variability as a possible psychophysiological outcome measure for studies
on treatment for non-suicidal self-injury and suicidal ideation.
Statistical analyses Multilevel between-group analyses will be conducted to test for the
between-group effects on the measures at baseline. Furthermore, a multiple regression
analyses, so that dimensional variables can be included as independent variables in the
model, for the pre and post measures. Regression analyses also allow for adjusting for the
effects of possible confounders on the outcome measures, such as age, sex, and intensity of
depressive symptoms. Furthermore, bootstrapping analysis will be conducted to examine
moderator and mediator effects on the outcome measures. Interpretation of the strength of
experimental effects will be guided by the use of effect size statistics. Baseline measures
of demographics, life experiences, and symptoms may also be used to predict outcomes or as
covariates in our analyses.
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