Clinical efficacy of a combined acceptance and commitment therapy, dialectical behavioural therapy, and functional analytic psychotherapy intervention in patients with borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) consists of a persistent pattern of instability in affective regulation, impulse control, interpersonal relationships, and self-image. Although certain forms of psychotherapy are effective, their effects are small to moderate. One of the strategies that have been proposed to improve interventions involves integrating the therapeutic elements of different psychotherapy modalities from a contextual behavioural perspective (ACT, DBT, and FAP). METHODS: Patients (n = 65) attending the BPD Clinic of the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz in Mexico City who agreed to participate in the study were assigned to an ACT group (n = 22), a DBT group (n = 20), or a combined ACT + DBT + FAP therapy group (n = 23). Patients were assessed at baseline and after therapeutic trial on measures of BPD symptom severity, emotion dysregulation, experiential avoidance, attachment, control over experiences, and awareness of stimuli. RESULTS: ANOVA analyses showed no differences between the three therapeutic groups in baseline measures. Results of the MANOVA model showed significant differences in most dependent measures over time but not between therapeutic groups. CONCLUSIONS: Three modalities of brief, contextual behavioural therapy proved to be useful in decreasing BPD symptom severity and emotional dysregulation, as well as negative interpersonal attachment. These changes were related to the reduction of experiential avoidance and the acquisition of mindfulness skills in all treatment groups, which may explain why no differences between the three different intervention modalities were observed. PRACTITIONER POINTS: Brief adaptations of acceptance and commitment therapy and dialectical behavioural therapy are effective interventions for BPD patients, in combined or isolated modalities, and with or without the inclusion of functional analytic psychotherapy. The reduction of experiential avoidance and the acquisition of mindfulness skills are related with the diminution of BPD symptoms severity, including emotional dysregulation and negative interpersonal attachment.

Changes in facial emotion expression during a psychotherapeutic intervention for patients with borderline personality disorder.

Emotional dysregulation is one of the main features of Borderline Personality Disorder (BPD). Therefore, it constitutes a central therapeutic objective of the interventions that have proven to be effective for these patients, including the Acceptance and Commitment Therapy (ACT). However, benefits on emotional regulation have been evaluated through self-report instruments, and an anatomically based, objective, and precise measurement of the ability to change the type, duration and frequency of emotions is still needed. OBJECTIVE: To assess facial emotion expression, valence and arousal during an ACT based intervention, between initial, middle and final therapeutic sessions for BPD patients. METHOD: Using the FaceReader 7.0, 29 recordings of individual therapeutic sessions for BPD patients during an ACT intervention trial were analyzed. RESULTS: Happiness and fear intensity increase from the beginning to the end of the sessions, while sadness decreases. Emotional valence exhibits a significant decrease in its negative value during sessions from -0.13 (S.D. = 0.12) at the initial part of the sessions to -0.06 (S.D. = 0.08) by the end of the sessions, with a moderate effect size (Cohen d = 0.69). Emotional arousal increased from the beginning to the end of sessions and whole intervention. CONCLUSION: The emotional valence and arousal differed according to the psychotherapeutically process involved during ACT intervention, suggesting that the systematic analysis of facial expressions allows a rigorously examination of the relations between emotions, physiological processes, and instrumental behavior experimented though a psychotherapeutically process.

A comprehensive review of research on Functional Analytic Psychotherapy.

Functional Analytic Psychotherapy (FAP; Kohlenberg & Tsai, 1991) is a transdiagnostic approach to outpatient psychotherapy that presented guidelines to instantiate the behavioral principle of natural, social reinforcement applied to idiographic behavioral targets within a genuine and authentic psychotherapy relationship. We present the first comprehensive review of research on FAP, including qualitative studies, uncontrolled and controlled single-case designs, group designs, and studies on training therapists in FAP. We conclude that current research support for FAP is promising but not sufficient to justify claims that FAP is research-supported for specific psychiatric disorders. There is stronger support for FAP's mechanism of therapist-as-social reinforcer: FAP techniques, when appropriately applied to idiographically defined behavioral problems-primarily in the realm of social functioning-produce positive change in those behaviors.