Mothers with borderline personality disorders' experiences of mother-infant dialectical behavior therapy.

BACKGROUND: Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother-infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother-infant relationship. The qualitative evaluation may provide complementary information. AIMS: This study aimed to explore the subjective experiences of women who had completed MI-DBT. MATERIAL AND METHODS: Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes. RESULTS: Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability. DISCUSSION AND CONCLUSIONS: This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain.

Perinatal and infant mental health in Australia: moving forward towards REAL prevention and early intervention - can we do it?

OBJECTIVES: Australia has been at the forefront of appropriate early intervention. Prevention of mental illness in infants by early identification and intervention in the mental health of their mothers has stalled since the cessation of funding through the National Perinatal Depression Initiative (NPDI, 2009-2015). Whilst screening for maternal mental illness has been widely implemented throughout Australia during the last two decades, services are now diminishing and great opportunities to ride the crest of a wave for appropriate mental illness intervention are receding. Reviews of history and interventions internationally may help guide future directions. CONCLUSIONS: Advocacy through across-agency and across-political-party support has been markedly successful for perinatal and infant mental health in the United Kingdom. A solid foundation exists in Australia. Australian psychiatrists have the ability to continue to change the face of prevention and early intervention.

Work participation for people with severe mental illnesses: An integrative review of factors impacting job tenure.

BACKGROUND: Enabling people with severe mental illness to sustain employment remains a challenge. This is despite most wishing to be employed, and the development of effective vocational interventions and employment supports for this population. To better understand how to enable their sustained involvement in the workforce, this review sought to identify, analyse and summarise studies investigating the factors that impact the job tenure of workers with severe mental illness, irrespective of the type of employment support they received. METHODS: An integrative literature review approach was employed to locate, appraise and synthesise quantitative and qualitative research focused on job tenure published in the 20 years up to 2013. Findings from nineteen studies were extracted and integrated using thematic analytic strategies. RESULTS: Job tenure was mostly conceptualised across the reviewed studies as time spent in individual jobs rather than as ongoing participation in the workforce. Three themes describe the factors contributing to job tenure: (1) the worker's experience of doing the current job; (2) natural supports in the workplace; and (3) strategies for integrating work, recovery and wellness, each of which could either support or impede ongoing employment. CONCLUSION: Occupational therapists, other vocational specialists and mental health staff can use these factors as a guide to supporting people with severe mental illness in employment. More detailed examination of job tenure is required in future research not only on job duration but also on the quality of jobs held, their value for career development and the role of services in supporting tenure.

Enabling occupational participation and social inclusion for people recovering from mental ill-health through community gardening.

INTRODUCTION: There is a need for mental health practitioners to understand how inclusive environments that enable participation can be developed. This paper presents the findings from an ethnographic exploration of Mind 'Sprout', a supported community garden situated in inner-city Melbourne. The study explored how this community development project created a socially inclusive environment, and enabled occupational participation among people recovering from mental ill-health. METHODS: Consistent with the ethos of ethnography, data were collected through participant observation and asking questions of people as they participated at 'Sprout'. Six individual interviews and review of organisational documents were also conducted. Qualitative analysis was used to identify the understandings of how the Sprout community was created and experienced by its members. RESULTS: Three interrelated themes were revealed: Sprout community garden enabled social inclusion and occupational participation by creating community, creating a flexible environment that supports participation and creating a learning environment. The way Sprout operated enabled its members to participate together in occupation and to interact socially within the garden community and beyond as part of the local community. CONCLUSION: Sprout has developed a philosophy of active participation. The findings point to the opportunities that community development projects offer for creating environments that enable participation and social inclusion. They also suggest that an opportunity exists for occupational therapists to broaden their practise by leading or collaborating in these projects.

Infants of emotionally dysregulated or borderline personality disordered mothers: Issues and management in primary care

BACKGROUND: Knowledge has increased regarding the developmental needs and capabilities of infants, and parental behaviours that support optimum infant development. Despite a better understanding of the emotional dysregulation in borderline personality disorder (BPD) and its effects on infants, general practitioners have had few guidelines for how to recognise and help emotionally dysregulated mother-infant dyads. OBJECTIVE: This article focuses on the behaviours and needs of infants whose mothers have BPD, including knowledge and skills for primary care practitioners to help these troubled families. DISCUSSION: Understanding the adequacy of parenting and troubling infant signs, such as hypervigilance, can potentially lead to either more intervention in primary care, including support, reassurance, guidance regarding development and interaction, and enhanced family support or else specialist referral for enhanced infant care. Infants’ needs are urgent, and timely intervention can begin a better life trajectory for infant and mother.

A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants.

OBJECTIVES: Few treatments have been described to treat the population of women with borderline personality structure who present in a dysregulated state with their infants. Therefore, a new treatment program was developed for this target group. METHODS: A total of 45 women, who were identified clinically as meeting full or partial diagnostic criteria for borderline personality disorder (BPD) and having an infant younger than 3 years of age, were offered entry with their infant(s) into specialized dialectical behavior therapy groups, adapted to focus on parenting and the mother-infant relationship. Outcomes measured included maternal mood and anxiety, BPD functioning, parenting sense of competence, parental reflective functioning, and caregiver-infant interaction (CARE Index). Infants received high-quality child care while mothers attended each group, with dyadic reunions a further therapeutic focus each week. RESULTS: A total of 29 women who met clinical or self-report measures for BPD and were offered group therapy began the program, 21 (72%) of whom completed the 24-week group program, with complete premeasures and postmeasures available for 20 dyads. Of the 20 women, 15 met full diagnostic criteria for BPD and 5 met partial criteria. Significant improvements were noted in maternal mood, with positive changes on 2 subscales of the Parental Reflective Function Questionnaire (prementalizing and increased curiosity in mental states); significant reductions in anxiety and BPD symptomatology were also observed. Only a medium effect size was found for parenting sense of competence, and in smaller numbers of participants as this scale was introduced later. It should particularly be noted that 15 dyads showed substantial change on the CARE Index, indicating improvement in dyadic relationships. CONCLUSIONS: This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients.