A feasibility randomised controlled trial with an embedded qualitative evaluation of perinatal emotional skills groups for women with borderline personality disorder: protocol for the EASE study.

BACKGROUND: Borderline personality disorder (BPD) is a severe mental disorder characterised by emotional instability, impaired interpersonal functioning and an increased risk of suicide. There is no clear evidence about how best to help women with BPD during the perinatal period. Perinatal Emotional Skills Groups (ESGs) consist of 12 group sessions, focussing on core skills in emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness and how these skills can best be utilised during the perinatal period. Prior observational research has shown that perinatal ESGs may help women with BPD. We set out to test the feasibility of conducting a randomised controlled trial to investigate the clinical effectiveness of perinatal ESGs. METHODS: A two-arm, parallel-group, feasibility randomised controlled trial of Perinatal ESGs in addition to Treatment as Usual (TAU) versus TAU for women aged over 18 years, who are likely to have a diagnosis of BPD and are either pregnant or are within 12 months of having a live birth. We will exclude women who have a co-existing organic, psychotic mental disorder or substance use dependence syndrome; those with cognitive or language difficulties that would preclude them from consenting or participating in study procedures; those judged to pose an acute risk to their baby and those requiring admission to a mother and baby unit. After consenting to participation and completing screening assessments, eligible individuals will be randomly allocated, on a 1:1 ratio, to either ESGs + TAU or to TAU. Randomisation will be stratified according to recruitment centre. Feasibility outcomes will be the proportion of participants: (1) consenting; (2) completing baseline measures and randomised; (3) completing the intervention and (4) completing follow-up assessments. All study participants will complete a battery of self-report measures at 2 and 4 months post-randomisation. A nested qualitative study will examine participants' and therapists' experiences of the trial and the intervention. DISCUSSION: Evidence is lacking about how to help women with BPD during the perinatal period. Perinatal ESGs are a promising intervention and if they prove to be an effective adjunct to usual care, a large population of vulnerable women and their children could experience substantial health gains. TRIAL REGISTRATION: ISRCTN80470632.

A pilot Web based positive parenting intervention to help bipolar parents to improve perceived parenting skills and child outcomes.

BACKGROUND: Children of bipolar parents are at elevated risk for psychiatric disorders including bipolar disorder. Helping bipolar parents to optimize parenting skills may improve their children's mental health outcomes. Clear evidence exists for benefits of behavioural parenting programmes, including those for depressed mothers. However, no studies have explored web-based self-directed parenting interventions for bipolar parents. AIMS: The aim of this research was to conduct a pilot study of a web-based parenting intervention based on the Triple P-Positive Parenting Programme. METHOD: Thirty-nine self-diagnosed bipolar parents were randomly allocated to the web-based intervention or a waiting list control condition. Parents reported on their index child (entry criterion age 4-10 years old). Perceived parenting behaviour and child behaviour problems (internalizing and externalizing) were assessed at inception and 10 weeks later (at course completion). Fifteen participants (4 control group and 11 intervention group) did not provide follow-up data. RESULTS: Levels of child behaviour problems (parent rated; Strengths and Difficulties Questionnaire) were above clinical thresholds at baseline, and problematic perceived parenting (self-rated; Parenting Scale) was at similar levels to those in previous studies of children with clinically significant emotional and behavioural problems. Parents in the intervention group reported improvements in child behaviour problems and problematic perceived parenting compared to controls. CONCLUSIONS: A web-based positive parenting intervention may have benefits for bipolar parents and their children. Initial results support improvement in child behaviour and perceived parenting. A more definitive study addressing the limitations of the current work is now called for.

Parenting and the emotional and behavioural adjustment of young children in families with a parent with bipolar disorder.

BACKGROUND: Children of parents with bipolar disorder are at increased risk of disturbance. AIMS: This study examined relationships between parental mood, parenting, household organization and child emotional and behavioural adjustment in families with a parent with bipolar disorder to determine areas of specific need for parenting support. METHOD: 48 parents were recruited through advertisements via self-help organizations. The study was conducted online. Parental mood and activity was assessed by self-report questionnaires (CES-D, ISS, MDQ and SRM); parenting was assessed using the Parenting Scale (PS). The SDQ was used to assess the parent's view of their child's emotional and behavioural difficulties. The Confusion, Hubbub and Order Scale (CHAOS) assessed household organization. RESULTS: Parents reported high levels of difficulties across all measures and scores were above clinical cut-offs on most scales. Children were reported as showing high levels of disturbance on the SDQ, including all sub-scales. Parenting and depression scores were significantly positively correlated, as were depression, parenting and CHAOS score. Regression analyses indicated that CHAOS was the strongest predictor of Total Difficulties and Emotional Symptoms on the SDQ. CONCLUSIONS: Families are likely to benefit from interventions tailored to meet their parenting needs.

Positive and negative appraisals of the consequences of activated states uniquely relate to symptoms of hypomania and depression.

Individuals may appraise internal states positively or negatively. Positive appraisals involve desiring or pursuing the state or experience, while negative appraisals involve dreading or avoiding the experience. The extent to which individuals make extreme positive or negative appraisals of high, activated, energetic states might determine whether they experience symptoms of high or low mood. This study extends the existing literature by considering the role of opposing appraisals and beliefs about the same internal states and by controlling for the potential correlation between depression and activation symptoms. Extreme, positive and negative appraisals of activated mood states related distinctly to experiences of activation and depression symptoms respectively, in an analogue sample (n=323). Positive appraisals of activated internal states were uniquely associated with elevated activation and hypomania symptoms. Negative appraisals of the same states were uniquely associated with elevated depression symptoms. Opposing appraisals of internal states may underlie mood swing symptoms.

Principal components analysis of the hypomanic attitudes and positive predictions inventory and associations with measures of personality, cognitive style and analogue symptoms in a student sample.

BACKGROUND: An integrative cognitive model proposed that ascribing extreme personal appraisals to changes in internal state is key to the development of the symptoms of bipolar disorder. The Hypomanic Attitudes and Positive Predictions Inventory (HAPPI) was developed to measure these appraisals. AIMS: The aim of the current study was to validate an expanded 61-item version of the HAPPI. METHOD: In a largely female student sample (N = 134), principal components analysis (PCA) was performed on the HAPPI. Associations between the HAPPI and analogue bipolar symptoms after 3 months were examined. RESULTS: PCA of the HAPPI revealed six categories of belief: Self Activation, Self-and-Other Critical, Catastrophic, Extreme Appraisals of Social Approval, Appraisals of Extreme Agitation, and Loss of Control. The HAPPI predicted all analogue measures of hypomanic symptoms after 3 months when controlling for baseline symptoms. In a more stringent test incorporating other psychological measures, the HAPPI was independently associated only with activation (e.g. thoughts racing) at 3 months. Dependent dysfunctional attitudes predicted greater conflict (e.g. irritability), depression and reduced well-being, hypomanic personality predicted self-reported diagnostic bipolar symptoms, and behavioural dysregulation predicted depression. CONCLUSIONS: Extreme beliefs about internal states show a modest independent association with prospective analogue bipolar symptoms, alongside other psychological factors. Further work will be required to improve the factor structure of the HAPPI and study its validity in clinical samples.

Can technology and the media help reduce dysfunctional parenting and increase engagement with preventative parenting interventions?

In an evaluation of the television series "Driving Mum and Dad Mad," 723 families participated and were randomly assigned to either a standard or technology enhanced viewing condition (included additional Web-support). Parents in both conditions reported significant improvements from pre- to postintervention in their child's behavior, dysfunctional parenting, parental anger, depression, and self-efficacy. Short-term improvements were maintained at 6-months follow-up. Regressions identified predictors of program outcomes and level of involvement. Parents who watched the entire series had more severe problems at preintervention and high sociodemographic risk than parents who did not watch the entire series. Few sociodemographic, child, or parent variables assessed at preintervention predicted program outcomes or program engagement, suggesting that a wide range of parents from diverse socioeconomic status benefited from the program. Media interventions depicting evidence-based parenting programs may be a useful means of reaching hard to engage families in population-level child maltreatment prevention programs.