The effectiveness of group skills training for women with borderline personality disorder

Abstract

English: From the available literature, it is a well-known fact that individuals with Borderline Personality Disorder (BPD) are particularly difficult to treat and represent a true challenge to the motivation of any clinician or therapist. With this in mind and also taking into consideration the prevailing negative attitude toward borderline individuals, Linehan lay the grounds for Dialectical Behaviour Therapy (DBT) in the early 1980's. She proposed a treatment approach that would help alleviate the pain experienced by borderline individuals, promote the learning of vital behavioural and problem solving skills, and provide a supportive and encouraging environment. At the same time the emotional resources of the therapist would also be safeguarded. DBT is presently an empirically researched treatment approach that delivers highly satisfactory results and is also being used in the treatment of other major disorders. The goal of this study is to determine whether DBT group skills training is effective in improving the self esteem and reducing specific problematic behaviours - impulsivity and self-destructiveness - of women with a diagnosis of BPD in an inpatient setting. The following hypothesis has been formulated: Female patients diagnosed with BPD and having participated in DBT group skills training are more likely to demonstrate improved selfesteem, diminished self-destructiveness and lower impulsivity than female BPD patients not having participated in DBT group skills training. A study of BPD is made in order to understand the complexities underlying the disorder. The most common therapeutic approaches to the treatment of BPD are outlined and reviewed in order to highlight the weight DBT brings to the field as an empirically researched therapy. The theoretical framework of DBT is discussed in depth in order to understand the rationale of the group skills training and to underline the impact a shift in paradigm can have in therapeutic outcomes. Finally, the targeted behaviours of the study are discussed as core aspects of BPD The research methodology and the results are described. A total of 40 inpatients of Tara Hospital, Johannesburg, participated in the research. The above stated hypothesis was investigated by means of the Hotelling T2-test to determine whether there were significant differences between the experimental group and the control group with respect to the four dependent variables - selfesteem, self-destructiveness, impulsive urge, impulsive action - at the three evaluation times - admission, discharge, one-month follow-up. Significant differences between the groups were only found at the one-month follow-up evaluation and these were then further analysed by means of the t-test for independent groups. The results of the study indicated that, although individuals from both groups showed improved symptoms at the time of their discharge, only those who participated in the DBT group skills training were able to maintain the improvements over a one-month period. Thus, it can be concluded that DBT was more effective than the general ward program in targeting the specific problems afflicting the borderline individuals and in offering the appropriate skills to deal with such problems. If borderline individuals are equipped with better skills to effectively deal with and control their self-destructive and impulsive inclinations, then the therapists' emotional resources will not be continuously drained and thus motivation and willingness to work with borderline individuals will increase. Also, with effective treatment, medical costs will also be reduced. In conclusion, this study has shown the importance and necessity of further research on BPD in South Africa, as there appears to be a lack of local information and data on this population group.

Afrikaans: Uit beskikbare letteratuur blyk dit dat individuele met Grenpersoonlikheidversteuring (GPV) besonder moeilik is om te behandel en dus ware uitdagings tot die motivering van enige klinikus of terapeut rig. Met bogenoemde in gedagte en teen die agtergrond van die negatiewe sentiment rondom persone met Grenspersoonlikheid-versteurings, lê Linehan die grondslag vir Dialektiese Gedrags Terapie (DGT) in die vroeë 1980's. Sy stel 'n benadering voor wat poog om die pyn wat deur hierdie groep pasiënte ervaar word, te verlig, die aanleer van belangrike gedrags- en probleemoplossingsvaardighede te fasiliteer en wat 'n ondersteunende en aanmoedigende klimaat vir behandeling sal bevorder. Ter selfde tyd, word die emosionele hulpbronne van die terapeut ook hierdeur beskerm. DGT is 'n empiriese nagevorsde benadering wat hoogs bevredigende resultate lewer en ook gebruik word in die behandeling van ander groepe sielkundige versteurings. Die doel van die studie is om vas te stelof DGT-groepopleiding effektief is vir die bevordering van selfvertroue en die vermindering van spesifieke problematiese gedragsimptome - impulsiewieteit en selfvernietiging - by vrouens wat gediagnoseer is met (GPV) in 'n binnepasiënt omgewing. Die volgende hipotese is geformuleer: Vroulike pasiënte wat gediagnoseer is met GPV en wat deelgeneem het aan DGT-groepvaardigheidsopleiding sal meer waarskynlik verbeterde selfvertroue, verminderde self-vernietining en laer impulsiwiteit toon as vroulike pasiënte wat met GPV gediagnoseer is en nie aan die DGTgroepvaardigheidsopleiding deelgeneem het nie. 'n Studie van GPV word gemaak met die doeI om die kompleksiteit onderliggend aan die versteuring te begrens. Die mees algemene terapeutiese benaderings vir die behandeling van GPV word ook uitgelig ten einde die bydrae wat deur DGT in hierdie verband gelewer word, te bepaal en die empiriese navorsing wat hierdie bydrae ondersteun of weerlê, te rapporteer. Die teoretiese raamwerk van DGT is bespreek ten einde die rasionaal van die groepvaardigheidsopleiding te begryp en om die impak van 'n DGTparadigmaskuif op terapeutiese uitkomste uit te lig. Ten slotte word die teikengedrag van die studie bespreek as sleutel aspekte van GPV. In totaal het 40 pasiënte van Tara Hospitaal in Johannesburg aan die navorsing deelgeneem. Die navorsingshipoteses is ondersoek deur middel van die Hotelling T2 toets om vas te stelof daar 'n betekenisvolle verskil was tussen die eksperimentele groep en die kontrolegroep betreffende die vier afhanklike veranderlikes - selfvertroue, self-vernietiging, impulsiewe gedrag, impulsiewe aksie - ten tye van drie evalueringstye naamlik by opname, met ontslag en 'n maand na ontslag. Betekenisvolle verskille tussen die groepe is gevind met die een- maand opvolg. Hierdie versklille is verder ontleed met behulp van die die t-toets vir onafhanklike groepe. Die resultate van hierdie studie dui daarop dat, alhoewel individue in beide die eksperimentele en kontolegroepe verbeterde simptome getoon het ten tye van ontslag, het slegs proefpersone in die eksperimentele groep daarin geslaag om hierdie vordering vol te hou na 'n een-maand periode. Daar kan dus tot die gevolgtrekking gekom word dat DGT meer effektief was as die algemene saalprogam om die spesifieke probleme wat grenslyn individue affekteer aan te spreek soos gemeet een-maand na ontslag. Dit wil dus voorkom asof die grenslyn individue wat toegerus word met verbeterde vaardighede om kontrole uit te oefen oor selfvernietiging en impulsiewe gedrag in 'n mindere mate die terapeut emosioneel dreineer wat die terapeut laat met verhoogde motiveringsvlakke om hulp aan die individu te bied. Ten slotte het die studie die leemtes in navorsing oor GPV in Suid-Afrika uitgewys en die belangrikheid en noodsaaklikheid van verdere navorsing in hierdie verband onderstreep.