Efficacy of "Family Connections", a program for relatives of people with borderline personality disorder, in the Spanish population: study protocol for a randomized controlled trial.

BACKGROUND: Patients with borderline personality disorder (BPD) experience significant affect regulation difficulties that cause serious consequences in their work, emotional, and social environments. This dysfunctional pattern also produces great suffering and a heavy burden on their relatives. Fortunately, some studies show that treatment of relatives of people with BPD begins to be important in the patients' recovery and in improving family dynamics. One of the treatments that has obtained the most empirical support is Family connections (FC). This 12-session program is an adaptation of different Dialectical Behavior Therapy strategies. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre-post treatment and follow-up assessments. The results of these studies and subsequent replications showed an improvement in family attitudes and caregiver burnout. Our research team adapted FC for delivery in the Spanish population. We intend to test the efficacy of this program versus a treatment as usual condition. Moreover, we aim to test the efficacy of this program and study its effectiveness (in terms of participants' acceptance). This paper presents the study protocol. METHODS: The study is a randomized controlled trial. The participants will be recruited in a Personality Disorders Unit and randomly assigned to one of two treatment conditions: Family Connections group (FC) or Treatment As Usual (TAU). Primary outcome measures will be the BAS and FAD-GFS. Secondary outcomes will include DASS-21, FES, GS, and QLI. Participants' treatment acceptance and degree of satisfaction will also be measured. Participants will be assessed at pre-, post-treatment, and 6-month follow-up. Intention to treat and per protocol analyses will be performed. DISCUSSION: This is the first study on FC for relatives of people with borderline personality disorder (BPD) compared to an active condition (TAU), and this is the first time relatives' and patients' data will be analyzed. In addition, it is the first study to test the efficacy of the program in Spain. This intervention could contribute to improving the efficiency and effectiveness of current treatment programs for relatives of people with BPD, help to decrease burden, and improve the family connection. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04160871. Registered November 15th 2019.

Psychometric properties of the Spanish version of the involvement evaluation questionnaire in caregivers of patients with borderline personality disorders.

The involvement evaluation questionnaire (IEQ) was created to evaluate the caregiver's experience of burden and the consequences of providing care to people with psychotic disorders. To date, the IEQ has not been validated with caregivers of people diagnosed with borderline personality disorder (BPD). The main objective of the study was to confirm the psychometric properties and factorial structure of the Spanish version of the IEQ in 151 caregivers of people with BPD, with an average age of 54.52 (SD = 9.91). Two models were tested by means of confirmatory factor analysis, following the original factor structure. The Models 1 and 2 displayed adequate fit, with comparative fit index and Tucker-Lewis index > 0.90 and root-mean-square root of approximation < 0.08; however, Model 2 was more parsimonious. The Cronbach's alphas are adequate, ranging from 0.70 to 0.85. The consequences of providing care to people with BPD had a low or moderate association with the Level of Expressed Emotion scores. IEQ scores of caregivers of people diagnosed with BPD with psychiatric comorbidity did not differ from those of caregivers of people diagnosed with BPD without psychiatric comorbidity. The IEQ has adequate psychometric properties and can be utilized to assess burden in caregivers of people with BPD.

Psychometric properties of the questionnaire of sociocultural influences on the aesthetic body shape model (CIMEC-26) in female Spanish adolescents.

The purpose of the present study was to analyse the psychometric properties of the 'Questionnaire of Sociocultural Influences on the Aesthetic Body Shape Model' (CIMEC-26) in a Spanish adolescent population. This questionnaire measures the influence of agents and situations that transmit the current aesthetic model, and assesses environmental influences favouring thinness. The CIMEC-26 was administered to a sample of 4031 female primary and secondary school students ranging in age from 10 to 17 years (M = 14, SD = 1.34). Results suggested that the CIMEC-26 has acceptable internal consistency (α = .93). The oldest group (15-17 years) had the highest scores on all factors and the highest total scores, suggesting greater influence of the aesthetic body shape model and higher vulnerability to social pressure to achieve it. Factor analysis suggested three moderately interrelated components of the scale. Confirmatory factor analysis showed that both the three-factor solution and the original five-factor structure had good fit indices, although the latter showed the best fit. The CIMEC-26 proved to be an effective instrument for research on the social influence on the aesthetic body model in female adolescents.

Mindfulness Component in a Dialectical Behavioural Therapy Group Intervention for Family Members of Borderline Personality Disorder Patients.

BACKGROUND: Family members of people with borderline personality disorder (BPD) are seriously affected by the disease and it is common for them to ask for professional help. The main objective of this study is to assess, in an open clinical trial, a treatment protocol based on Dialectical Behaviour Therapy (DBT) strategies for relatives of individuals with BPD, compared to the same protocol plus a mindfulness component (DBT-M). METHOD: The interventions were conducted in a sample of 108 relatives of 83 patients diagnosed with BPD from a Specialized Unit for Personality Disorders. Relatives and patients completed the assessment protocol before and after the intervention. RESULTS: Significant improvements in almost all the relevant variables tested were observed after the treatment in both the relatives and the patients. However, there were only statistically significant differences between the groups in the negative attitude towards the illness, where relatives in the DBT-M condition showed greater improvement than those in the DBT condition. CONCLUSIONS: The results indicate that the intervention helps both patients and relatives to improve on key issues. It is essential to consider and offer support to the families of people with severe psychological disorders.

Direct Experience While Eating in a Sample With Eating Disorders and Obesity.

Background: Individuals with eating disorders might be characterized by lower levels of direct engagement with the eating experience. This study aims to explore similarities and differences in direct experience while eating in four different weight conditions and healthy controls (HCs): anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS), and obesity (OB). Methods: A total sample of 143 women were recruited. Participants were asked to eat an orange slice and write down 10 things about the experience of eating, classifying the focus of these thoughts as either experiential ("direct experience") or analytical ("thinking about"). A direct experience index (DEI) was calculated by dividing the number of times a participant classified an experience as a "direct experience" (the numerator) by the total number of observations. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) and rated their level of anxiety after the task. Results: Between-groups significant differences were found on the DEI, with individuals in the OB group scoring higher than AN and BN, and similar to HC. After the task, the AN group reported significantly higher anxiety levels than HC, and EDNOS reported more anxiety than HC and OB. Between-group significant differences were also found for all the FFMQ facets. Conclusion: AN and BN presented lower access to direct experience while eating. Individuals with OB did not respond in the same way as the other clinical groups, showing a similar performance to HC.

Meaning in life and non-suicidal self-injury: A follow-up study with participants with Borderline Personality Disorder.

Non-suicidal self-injury (NSSI) is considered one of the defining features of people diagnosed with Borderline Personality Disorder (BPD). Longitudinal studies are needed to identify factors predicting future NSSI in BPD participants. Several studies have shown that low meaning in life is associated with mental health problems, addiction problems, depression, hopelessness, and suicide. The purpose of this paper is to examine whether meaning in life predicts the frequency of NSSI behaviors during the one-year follow-up. The sample was composed up of 80 participants with a BPD diagnosis. We assessed the frequency of NSSI behaviors over a 12-month follow-up period. The results suggest that the participants who had low meaning in life had more frequency of NSSI, depression, and hopelessness at baseline, and more frequency of NSSI during the follow-up, than participants with high meaning in life. The predictor variables: Frequency of NSSI at base line, depression, hopelessness, and meaning in life, significantly predicted the frequency of NSSI during the one-year follow-up. Therefore, meaning in life was the only predictor of NSSI during the follow-up period.