Early Change in Coping Strategies in Responsive Treatments for Borderline Personality Disorder: A Mediation Analysis

• Published in: Journal of consulting and clinical psychology Vol. 85; no. 5; pp. 530 - 535
• Main Authors: Kramer, Ueli, Keller, Sabine, Caspar, Franz, de Roten, Yves, Despland, Jean-Nicolas, Kolly, Stéphane
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-05-2017
• Subjects: Adaptation, Psychological; Adult; Behavior change; Borderline Personality Disorder; Borderline Personality Disorder - psychology; Borderline Personality Disorder - therapy; Change Strategies; Clinical psychology; Clinical trials; Coping Behavior; Coping strategies; Emotional disorders; Emotional Regulation; Emotions; Female; Human; Humans; Male; Mental health care; Middle Aged; Motivation; Personality disorders; Psychological distress; Psychotherapeutic Processes; Psychotherapy - methods; Responsiveness; Self control; Therapeutic alliances; Treatment methods; Treatment Outcome; Young Adult; motive-oriented therapeutic relationship; mediation; coping; borderline personality disorder; therapist responsiveness
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000196

Background: Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Therefore, change in the frequency of certain patient's coping strategies-aiming at emotion regulation-are among the most promising mechanisms of change in treatments for BPD. In parallel, it was highlighted that therapist responsiveness significantly contributed to outcome across treatment approaches (Stiles, 2009). Based on a randomized controlled trial (Kramer et al., 2014), the present process-outcome mediation analysis aims at examining the patients' early change in frequency of coping strategies-in particular the decrease in behavioral forms of coping-as potential mechanism of change in responsive treatments for BPD. Method: A total of 57 patients with BPD were included in the present analysis, out of whom 27 were randomly assigned to a 10-session psychiatric treatment and 30 to a 10-session psychiatric treatment augmented with the responsive intervention of the motive-oriented therapeutic relationship (Caspar, 2007). The 1st, 5th, and 9th session of each therapy were transcribed and analyzed using the Coping Action Pattern Rating Scale (Perry et al., 2005; 171 sessions analyzed in total), a validated observer-rated method for assessing coping strategies in the therapy process. Psychological distress was assessed using the OQ-45 at intake, after Session 5, and after Session 10. Results: The results confirmed a responsiveness effect associated with the motive-oriented therapeutic relationship and showed a significant decrease in frequency of behavioral forms of coping, F(1, 54) = 3.09, p = .05, d = .56, which was not different between the 2 conditions. In addition, we demonstrated that the early decrease in behavioral forms of coping between Sessions 1 and 5 partially mediated the link between the group assignment and the change in psychological distress between Sessions 5 and 10. Conclusions: These results shed light on the centrality of therapist responsiveness in treatments for BPD and its impact on very early change in patient's in-session behavioral coping strategies, contributing to the effectiveness of short-term treatments for BPD.
What is the public health significance of this article?
It is important for clinicians to assess the qualities of coping strategies as they occur within the session facing a patient with borderline personality disorder. Clinicians may individualize their interventions, guided by a case formulation, which produces direct specific effects on symptom relief between Sessions 5 and 10 sessions into treatment. Clinicians may monitor closely the borderline patient's use of specific emotion regulation strategies, in particular behavioral forms of coping. Decrease in behavioral forms of coping is linked with symptom relief and this process may be fostered by individualized interventions, both becoming indicators of good therapy process.