The Effectiveness of Cognitive-Analytic Therapy on Impulsivity and Dissociative Experiences of Borderline Personality Disordered Patients

Document Type : Original Article

Authors

1 Department of Clinical Psychology, University of Semnan, Semnan, Iran

2 Semnan University

Abstract

Introduction: Impulsivity is known as one of  the underlying and predictive factor in psychopathology  that considered as the most enduring features of borderline personality disorder. Also, dissociative experiences are the most prominent components of this disorder. The aim of this study was to investigate the effectiveness of cognitive-analytical therapy (CAT) on impulsivity and dissociative experiences in patients with borderline personality disorder.
Method: This study was a semi-experimental research conducted in the form of pretest-posttest and follow-up with control group. The sample of this study included 20 male with borderline personality disorder in the prison of Semnan who were selected by an experienced psychiatrist based on the Structured Clinical Interview and Millon Clinical Multiaxial Inventory-III (MCMI-III). Participants were included randomly in two experimental groups (n=10) and one control group (n=10) and completed the Barratt Impulsivity Scale (BIS-II) and the Dissociative Experiences Scale (DES) in pretest, posttest and follow-up.  The experimental group received the cognitive-analytical therapy (CAT) for sixteen 120-minute sessions twice a week. Data were analyzed by mixed analysis of variance (ANOVA).
Results: The findings of this study showed that cognitive-analytic therapy (CAT) after 5 and 10 sessions had no significant effects on decreasing impulsivity and dissociative experiences of the experimental group compared to the control group, but after 16 sessions of intervention and one month follow-up, a significant effect on reduction of this symptoms was observed.
Conclusion: The results of the current study showed that cognitive-analytic therapy was an effective strategy to improve the symptoms of impulsivity and dissociative experiences inborderline personality and can be used as an effective therapeutic approach.

Keywords

Main Subjects

References

1- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub. 2013.
2- Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ. The borderline diagnosis I: psychopathology, comorbidity, and personaltity structure. Biological psychiatry. 2002; 51(12): 936-50.
3- American Psychiatric Association. Diagnostic and statistical manual of mental disorders-IV-TR. Washington, DC. 2000.
4- Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. American journal of psychiatry. 2001; 158(11): 1783-93.
5- Chabrol H, Montovany A, Ducongé E, Kallmeyer A, Mullet E, Leichsenring F. Factor structure of the borderline personality inventory in adolescents. European Journal of Psychological Assessment. 2004; 20(1): 59-65.
6- McCormick B, Blum N, Hansel R, Franklin JA, John DS, Pfohl B, et al. Relationship of sex to symptom severity, psychiatric comorbidity, and health care utilization in 163 subjects with borderline personality disorder. Comprehensive Psychiatry. 2007; 48(5): 406-12.
7- Kernberg OF. Borderline conditions and pathological Narcism, New York (Jason Aronson) 1975.
8- Fonagy P, Bateman AW. Mechanisms of change in mentalization‐based treatment of BPD. Journal of clinical psychology. 2006; 62(4): 411-30.
9- McCullough Jr JP. Treatment for chronic depression: Cognitive behavioral analysis system of psychotherapy (CBASP): Educational Publishing Foundation. 2003.
10- Akbari J, Aghamohammadian H, Ghanbari Hashem Abadi B. The Effectiveness of Cognitive-Behavioral Therapy and Medicinal Therapy on Anxiety and Impulsivity Symptoms in Men with Bipolar Disorder. Journal of Psychology. 2010; 13(3): 342-59.
11- Mazaheri M, Bardjali A, Ahadi H, Golshani F. Effectiveness of dialectical behavioral therapy in the treatment of borderline personality disorder. Journal of Psychological Research. 2011; 2(5): 1-25.
12- Fatehizadeh M, Shafi Abadi A, Etemadi A, Delaware A. Comparison of the Effectiveness of Two Methods of Contraceptive Behavior Therapy and Cognitive Behavioral Therapy in Reducing Symptoms of Patients with Borderline Personality Disorder in Isfahan. Quarterly Journal of Psychological Studies. 2007; 2(3): 7-24.
13- Vakili J, Kimiaee SA, Salehi-Fadardi J. The Effectiveness of Dialectical Behavior Therapy on Borderline Personality Disorder Symptoms of prisoners. Journal of Clinical Psychology. 2016;8(3):97-105.
14- Zargarani N, Mashhadi A, Tabibi Z. The Effectiveness of Emotion Regulation Group Training Based on Process Model of Gross on Behavioral and Cognitive Inhibition of Adolescent Girls with Syndrome of BPD and ADHD. Journal of Clinical Psychology. 2015;6(4).
15- Hoseini-Emam SS, Najafi M, Makvand-Hosseini Sh, Salavati M, Rezaei AM. Comparing the Effectiveness of Training Emotion Regulation Skills Based on Gross and Linehan Models on Emotion Regulation Strategies in Adolescents with Borderline Personality Disorder. Journal of Research in Behavioural Sciences. 2018;15(4):508-17.
16-Rashn Sh, Makvand-Hosseini Sh, Rezaei AM, Tabatabaee SM. The effect of long-term dynamic psychotherapy on the personality structure of patients with Dependent Personality Disorder. Journal of Clinical Psychology. 2018;9(4):1-12.
17- Ryle A, Low J. Cognitive analytic therapy.  Comprehensive handbook of psychotherapy integration: Springer. 1993; 87-100.
18- Akbari J, Aghamohammadi  H, Ghanbari Hashem Abadi B. The Effectiveness of Cognitive-Behavioral Therapy and Drug Therapy on Anxiety and Impulsivity Symptoms in Men with Borderline Personality Disorder. Principles of Mental Health. 2008; 10(4): 317-23.
19- Ryle A, Kerr IB. Introducing cognitive analytic therapy: Principles and practice: John Wiley & Sons; 2003.
20- Kellett S, Bennett D, Ryle T, Thake A. Cognitive analytic therapy for borderline personality disorder: therapist competence and therapeutic effectiveness in routine practice. Clinical psychology & psychotherapy. 2013; 20(3): 216-25.
21- Bateman AW, Ryle A, Fonagy P, Kerr IB. Psychotherapy for borderline personality disorder: Mentalization based therapy and cognitive analytic therapy compared. International Review of Psychiatry. 2007; 19(1): 51-62.
22- Trevarthen C. Intrinsic motives for companionship in understanding: Their origin, development, and significance for infant mental health. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health. 2001; 22(1‐2): 95-131.
23- Denman C. Cognitive–analytic therapy. Advances in Psychiatric treatment. 2001; 7(4): 243-52.
24- Denman C. The place of psychotherapy in modern psychiatric practice. Advances in psychiatric treatment. 2011; 17(4): 243-9.
25- Ryle A, Leighton T, Pollock P. Cognitive analytic therapy and borderline personality disorder: The model and the method: John Wiley & Sons Inc. 1997.
26- Fonagy P, Target M. Attachment and reflective function: Their role in self-organization. Development and psychopathology. 1997; 9(4): 679-700.
27- Clarke S, Thomas P, James K. Cognitive analytic therapy for personality disorder: randomised controlled trial. The British Journal of Psychiatry. 2013; 202(2) :129-34.
28- Chanen AM, Jackson HJ, McCutcheon LK, Jovev M, Dudgeon P, Yuen HP, et al. Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. The British Journal of Psychiatry. 2008; 193(6): 477-84.
29- Cowmeadow P. Deliberate self-harm and cognitive analytic therapy. International Journal of Short-Term Psychotherapy. 1994; 9: 135-50.
30- Fosbury J, Coles C. Cognitive analytic therapy with poorly controlled insulin-dependent diabetic patients. Psychology and diabetes care Chichester, UK: PMH Production. 1994.
31- Wildgoose A, Clarke S, Waller G. Treating personality fragmentation and dissociation in borderline personality disorder: a pilot study of the impact of cognitive analytic therapy. British Journal of Medical Psychology. 2001; 74(1): 47-55.
32- Beard H, Marlowe M, Ryle A. The management and treatment of personality-disordered patients: The use of sequential diagrammatic reformulation. The British Journal of Psychiatry.1990; 156(4): 541-5.
33- Kerr IB. Cognitive‐analytic therapy for borderline personality disorder in the context of a community mental health team: Individual and organizational psychodynamic implications. British Journal of Psychotherapy. 1999; 15(4): 425-38.
34- Ryle A, Beard H. The integrative effect of reformulation: Cognitive analytic therapy with a patient with borderline personality disorder. British Journal of medical psychology. 1993; 66(3): 249-58.
35- Chanen AM, Jackson HJ, McCutcheon LK, Jovev M, Dudgeon P, Yuen HP, et al. Early intervention for adolescents with borderline personality disorder: quasi-experimental comparison with treatment as usual. Australian and New Zealand Journal of Psychiatry. 2009; 43(5): 397-408.
36- Ryle A, Golynkina K. Effectiveness of time‐limited cognitive analytic therapy of borderline personality disorder: Factors associated with outcome. British Journal of Medical Psychology. 2000; 73(2): 197-210.
37- Wayne K, Goodman M. Medications for Obsessive-compulsive Disorder:    ; 2010 [Available from: www.ocdchicago.or.
38- McCormick EW. Change for the better: Self-help through practical psychotherapy: Sage. 2012.
39- Giesen-Bloo J, Van Dyck R, Spinhoven P, Van Tilburg W, Dirksen C, Van Asselt T, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of general psychiatry. 2006; 63(6): 649-58.
40- Smith TE, Koenigsberg HW, Yeomans FE, Clarkin JF, SELZER MA. Predictors of dropout in psychodynamic psychotherapy of borderline personality disorder. The Journal of psychotherapy practice and research. 1995; 4(3): 205.
41- Raj YP. Psychopharmacology of borderline personality disorder. Current psychiatry reports. 2004; 6(3): 225-31.
42- Barratt ES. Perceptual-motor performance related to impulsiveness and anxiety. Perceptual and Motor Skills. 1967; 25(2): 485-92.
43- Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. Journal of clinical psychology. 1995; 51(6): 768-74.
44- Ekhteyari H, Safai H, Esmaeili J, Atef G, Mohammad k, Edalati H, et al. Validity and Reliability of Persian Versions of Isans, Bart, Dickman, and Zuckerman Questionnaires in Determining Hazardous and Impulsive Behaviors. Iranian Journal of Psychiatry and Clinical Psychology. 2009; 14(3): 326-36.
45- Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. Journal of nervous and mental disease. 1986.
46- Renard SB, Pijnenborg M, Lysaker PH. Dissociation and social cognition in schizophrenia spectrum disorder. Schizophrenia Research. 2012; 137(1-3): 219-23.
47- Körlin D, Edman G, Nybäck H. Reliability and validity of a Swedish version of the Dissociative Experiences Scale (DES-II). Nordic Journal of Psychiatry. 2007; 61(2): 126-42.
48- Olsen SA, Beck JG. The effects of dissociation on information processing for analogue trauma and neutral stimuli: A laboratory study. Journal of anxiety disorders. 2012; 26(1): 225-32.
49- Sajadi SF, Zargar Y, Honarmand MM, Arshadi N. Designing and testing a model of some precedents and outcomes of borderline personality disorder in high school students of Shiraz. International Journal of School Health. 2015; 2(3).
50- Sajadi SF, Dehghanizadeh Z. A survey on the relationship between alexithymia and dissociation experiences with eating attitudes in girl students of Shahid Chamran University of Ahvaz. Journal of Shahrekord University of Medical Sciences 2016; 18(5): 8-17.
51- Bernstein E, Putnam FW, Ross CA, Torem M, Coons P, Dill D, et al. Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: A multicenter study. Am J Psychiatry. 1993; 150: 1030-6.
52- Marnat G. Psychoscience Guide, for clinical psychologists, counselors and psychiatrists. Translated by Hasan Pashashriffi and Mohammad Reza Nikkhoo.Tehran: Sokhan Publications. 1392.
53- Khawaja Mughi N. Preliminary Preparation of the Short Form of Million-Century Multi-Axis Clinical Questionnaire in Tehran. Tehran Psychiatric Institute. 1993
.
 
54- Sharifi AA, Molavi H, Namdari C. Triple Validity Multi-Axis Clinical Trial Milne-3. Journal of Applied Psychology. 2007; 9(34): 27-38.
55- First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for Axis I DSM-IV disorders. New York: Biometrics Research. 1994.
56- First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. SCID-I/P; 2002.
57- Sharifi V, Assadi SM, Mohammadi MR, Amini H, Kaviani H, Semnani Y, et al. A persian translation of the structured clinical interview for diagnostic and statistical manual of mental disorders: psychometric properties. Comprehensive psychiatry. 2009; 50(1): 86-91.
58- Bakhtiari M. Psychological Disorders in Patients with Physical Disorders: Tehran Psychological Institute.2000.
59- Kazemi H, Rasoulzade Tabatabaei S, Dezhkam M, Azadfallah P, Momeni K. Comparison of cognitive analytic therapy, cognitive therapy and medication on emotional instability,impulsivity and social  instability in bipolar II disorder. Journal of Behavioral Sciences. 2011; 5: 91-9.
60- Carradice A. ‘Five‐Session CAT’Consultancy: Using CAT to Guide Care Planning with People Diagnosed with Personality Disorder within Community Mental Health Teams. Clinical psychology & psychotherapy. 2013; 20(4): 359-67.
61- Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, et al. Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. American Journal of Psychiatry. 2007; 164(12): 1832-41.
62- Walters KN. Emotional responses to social rejection and failure among persons with borderline personality features: Dept. of Psychology-Simon Fraser University. 2008.
63- Gratz KL, Rosenthal MZ, Tull MT, Lejuez C, Gunderson JG. An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: The role of shame. Comprehensive psychiatry. 2010; 51(3): 275-85.
64- Motamedi A, Amirpour B. The effect of thinking styles on anger expression(in-out)and anger control(in-out)in university students. Journal of Behavioral Sciences. 2012; 6(1): 17-24.
65- Hamill M, Mahony K. ‘The long goodbye’: Cognitive analytic therapy with carers of people with dementia. British Journal of Psychotherapy. 2011; 27(3): 292-304.
66- Fozooni B. Cognitive analytic therapy: a sympathetic critique. Psychotherapy and Politics International. 2010; 8(2): 128-45.
67- Hepple J. Cognitive‐Analytic Therapy in a Group: Reflections on a Dialogic Approach. British Journal of Psychotherapy. 2012; 28(4): 474-95.
68- Thompson AR, Donnison J, Warnock‐Parkes E, Turpin G, Turner J, Kerr IB. Multidisciplinary community mental health team staff's experience of a ‘skills level’training course in cognitive analytic therapy. International Journal of Mental Health Nursing. 2008; 17(2): 131-7.
69- Kellett S. The treatment of dissociative identity disorder with cognitive analytic therapy: Experimental evidence of sudden gains. Journal of Trauma & Dissociation. 2005; 6(3): 55-81.
70- Kerr IB, Birkett PB, Chanen A. Clinical and service implications of a cognitive analytic therapy model of psychosis. Australian & New Zealand Journal of Psychiatry. 2003; 37(5): 515-23.
 

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  • Receive Date: 14 November 2017
  • Accept Date: 18 November 2018

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