BI-REAL: A 12-session DBT skills group intervention adapted for bipolar disorder - A feasibility randomised pilot trial.

International guidelines endorse psychological treatment for Bipolar Disorder (BD); however, the absence of a recognised gold-standard intervention requires further research. A Dialectical Behaviour Therapy (DBT) skills group intervention with 12 sessions was developed. This pilot randomised controlled trial (RCT) aims to evaluate the feasibility, acceptability, and outcomes variance of Bi-REAL - Respond Effectively, Assertively, and Live mindfully, tailored for individuals with BD, in preparation for a future RCT. METHODS: 52 participants (female = 62.7 %; mean age = 43.2 ± 11.1) with BD were randomised by blocks to either the experimental group (EG; n = 26; Bi-REAL + Treatment as Usual, TAU) receiving 12 weekly 90-minutes sessions, or the control group (CG; n = 26, TAU). Feasibility and acceptability were assessed with a multimethod approach (qualitative interviews, semi-structured clinical interviews and a battery of self-report questionnaires - candidate main outcomes Bipolar Recovery Questionnaire (BRQ) and brief Quality of Life for Bipolar Disorder (QoL.BD)). All participants were evaluated at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). RESULTS: Acceptability was supported by participants' positive feedback and ratings of the sessions and programme overall, as well as the treatment attendance (86.25 % of sessions attended). The trial overall retention rate was 74.5 %, with CG having a higher dropout rate across the 3-timepoints (42.31 %). A significant Time × Group interaction effect was found for BRQ and QoL.BD favouring the intervention group (p < .05). LIMITATIONS: The assessors were not blind at T1 (only at T2). Recruitment plan was impacted due to COVID-19 restrictions and replication is questionable. High attrition rates in the CG. CONCLUSIONS: The acceptability of Bi-REAL was sustained, and subsequent feasibility testing will be necessary to establish whether the retention rates of the overall trial improve and if feasibility is confirmed, before progressing to a definitive trial.

Validation of the Bipolar Recovery Questionnaire for the Portuguese Population: Recovery and Predictors in People with Bipolar Disorder.

INTRODUCTION: The paradigm in mental health care is progressively moving towards a recovery-focused perspective. Thus, there is a need for validated instruments to measure recovery in bipolar disorder (BD). The Bipolar Recovery Questionnaire (BRQ) is the most used instrument to assess it. The aim of this study was to translate and perform a cross-cultural adaptation of the BRQ to European Portuguese (PT-PT) and to explore further associations of recovery with sociodemographic and emotional regulation, as well as recovery predictors to inform future research and clinical practice. METHODS: The BRQ was forward-translated and back-translated until a consensus version was found, and a test-retest design was used to assess temporal stability. Participants were recruited in public hospitals and organizations supporting people with BD, either referred by their psychiatrists or psychologists or through self-referral. Eighty-eight individuals diagnosed with BD were recruited to complete a battery of Portuguese-validated self-report questionnaires to assess recovery (BRQ), clinical mood symptoms (Hospital Anxiety and Depression Scale), affect (Positive and Negative Affect Scale), well-being (brief Quality of Life for Bipolar Disorder; Satisfaction with Life Scale) and emotion regulation (Difficulties in Emotion Regulation Scale). RESULTS: The BRQ showed excellent internal consistency with a Cronbach alpha of 0.92, and test-retest exhibited good reliability (r = 0.88). Construct validity was confirmed through/by positive and moderate correlations with quality of life (QoL; r = 0.58) and positive affect (r = 0.52), and negative moderate correlations with depression (r = -0.64), and negative affect (r = -0.55). Both satisfaction with life (ß = 0.38, p = 0.010) and recovery (ß = 0.34, p = 0.022) impacted quality of life, supporting the BRQ's incremental validity. Depressive symptoms and emotion dysregulation accounted for 51% of its variance. CONCLUSION: The BRQ is a valid and reliable instrument to measure recovery in people with BD in the Portuguese population and is suitable for both clinical and research contexts.

Benchmarks for dialectical behavioural therapy intervention in adults and adolescents with borderline personality symptoms.

Background: Dialectical Behaviour Therapy (DBT) is a multi-component cognitive behavioural intervention with proven efficacy in treating people with borderline personality disorder symptoms. Establishing benchmarks for DBT intervention with both adults and adolescents is essential for bridging the gap between research and clinical practice, improving teams' performance and procedures. Aim: This study aimed to establish benchmarks for DBT using the EQ-5D, Borderline Symptoms List (BSL) and Difficulties in Emotion Regulation Scale (DERS) for adults and adolescents. Methods: After searching four databases for randomised controlled trials and effectiveness studies that applied standard DBT to people with borderline symptoms, a total of 589 studies were included (after duplicates' removal), of which 16 met our inclusion criteria. A meta-analysis and respective effect-size pooling calculations (Hedges-g) were undertaken, and heterogeneity between studies was assessed with I2 and Q tests. Benchmarks were calculated using pre-post treatment means of the studies through aggregation of adjusted effect sizes and critical values. Results: DBT aggregated effect sizes per subsample derived from RCTs and effectiveness studies are presented, along with critical values, categorised by age group (adults vs adolescents), mode of DBT treatment (full-programme vs skills-training) and per outcome measure (EQ-5D, BSL and DERS). Conclusions: Practitioners from routine clinical practice delivering DBT and researchers can now use these benchmarks to evaluate their teams' performance according to their clients' outcomes, using the EQ-5D, BSL and DERS. Through benchmarking, teams can reflect on their teams' efficiency and determine if their delivery needs adjustment or if it is up to the standards of current empirical studies.

The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample.

BACKGROUND: Although obsessive-compulsive (OC) symptoms are common in the perinatal period, measures to comprehensively assess their presence, frequency, interference and severity are lacking. The Perinatal Obsessive-Compulsive Scale (POCS) is the only self-report questionnaire with context-specific items. It includes items to assess perinatal-specific obsessions and compulsions, a severity scale and an interference scale. OBJECTIVES: (1) to analyze the validity and reliability of the Portuguese version of the POCS; (2) to find Obsessive-Compulsive Disorder (OCD) prevalence in postpartum and determine the POCS cut-off scores and its accuracy (sensitivity, specificity and predictive values) in screening for OCD according to DSM-5 criteria; (3) to describe the prevalence, content, severity, interference and onset of OC symptoms in the postpartum. METHODS: 212 women in postpartum filled in a booklet, including the POCS Portuguese preliminary version, the Perinatal Anxiety Screening Scale and the Postpartum Depression Screening Scale; they were interviewed with the Diagnostic Interview for Psychological Distress-Postpartum. RESULTS: Confirmatory Factor Analysis revealed that POCS presented acceptable fit indexes (χ2/df = 2.2971; CFI= 0.9319; GFI = 0.8574; TLI = 0.9127; RMSEA = 0.860, p < 0.001). The Cronbach's alphas were all > 0.800. The POCS cut-off point that maximized the Youden Index (J = 0.86, 95% CI [0.94-0.99]) was 20, corresponding to an Area Under the Curve of 0.970 (p < 0.001; Standard Error = 0.031; 95% CI: 0.937 to 0.988). The prevalence of postpartum OCD was 3.30%. The severity of thoughts and behaviors was moderate to severe for approximately 15% of women. For thirty-five percent of women, the onset of symptoms was in the first three months postpartum. CONCLUSIONS: The Portuguese version of POCS has good validity, reliability and accuracy and may be considered ready for use in both clinic and research fields. POCS provides specific information regarding symptoms and individual patterns experienced by each woman, which allows normalization, destigmatization and personalized intervention.

Early emotional memories and borderline symptoms: the mediating role of decentering

Several studies suggested that Borderline Personality Disorder is related to early invalidating and harsh environments, characterized by scarce experiences of warmth and safeness, and possibly traumatic shameful memories. On the other hand, the ability to take a stance and not get fused with one’s internal experiences seems to be linked to diminished psychopathology. This study aims to understand the relationship between early emotional memories (of warmth and safeness experiences and shameful traumatic events) and borderline symptoms. Moreover, intends to explore the mediator role of decentering on the relationship between early emotional memories and borderline symptoms in a sample of 304 subjects from general community. Results showed significant correlations between early emotional memories, decentering and borderline symptoms. Additionally, our findings suggest that decentering mediate, at least partially, the effect of early emotional memories on borderline symptoms. Taken together, these findings point out for the importance of promoting decentering abilities with patients presenting borderline features

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