Valerija Sipos

Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up.

There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treatments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopathology, as well as ratings on global psychosocial functioning, were significantly improved at post-treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopathology also suggest that this treatment needs further improvement.

Visceral fat deposition and insulin sensitivity in depressed women with and without comorbid borderline personality disorder.

Objective: Major depressive disorder (MDD) is associated with increased intra-abdominal fat, an important antecedent of noninsulin-dependent diabetes mellitus (NIDDM) and cardiovascular disorders. Furthermore, MDD is commonly accompanied by endocrine and immune dysregulation that has also been discussed in connection with the pathogenesis of NIDDM and ischemic heart disease. In borderline personality disorder (BPD), a dysregulation of the hypothalamic–pituitary–adrenal system has also been described. Therefore, our study aimed at examining visceral fat, insulin resistance, and alterations of cortisol and cytokines in young depressed women with and without comorbid BPD. Methods: Visceral fat was measured in 18 premenopausal women with MDD and in 18 women comorbid with MDD and BPD by means of magnetic resonance tomography at the level of the first lumbar vertebral body. Twelve BPD patients without MDD and 20 healthy women served as the comparison groups. Concentrations of fasting cortisol, tumor necrosis factor-&agr;, and interleukin-6 were measured, and indicators of insulin resistance and &bgr;-cell sensitivity were calculated according to the homeostasis assessment model. Results: We found increased visceral fat in women comorbid with MDD and BPD, and to a lesser extent, in women with MDD but without BPD. Insulin sensitivity was reduced in comorbid patients. Serum interleukin-6 (IL-6) and tumor necrosis factor-&agr; concentrations were significantly increased in both groups of depressed patients. Reduced insulin sensitivity correlated with the amount of visceral fat and with serum concentrations of IL-6. Conclusion: Young depressed women with and without comorbid BPD display increased visceral fat and may constitute a risk group for the development of NIDDM and the metabolic syndrome. Our data support the hypothesis that the immune and endocrine alterations associated with MDD and BPD may contribute to the pathophysiologic processes associated with NIDDM. BMI = body mass index; BPD = borderline personality disorder; ES = effect size; HOMA = homeostasis model assessment (-IR: insulin resistance; −S: &bgr;-cell sensitivity); IL-6 = interleukin-6; MDD = major depressive disorder; NIDDM = noninsulin-dependent diabetes mellitus; TNF-&agr; = tumor necrosis factor-&agr;; VF/L = visceral fat at the level of the first lumbar vertebral body (VF/L1-: 10 mm below L1; VF/L1+ = 10 mm above L1).

Development and Psychometric Characteristics of the Dissociation Tension Scale

The newly developed Dissoziations-Spannungs-Skala (Dissociation Tension Scale; DSS) is a self-rating instrument for the assessment of psychological and somatoform dissociative features (ranging from normal up to pathological) as well as aversive inner tension occurring within the past 7 days. The DSS contains 21 items assessing dissociative symptoms and 1 additional item assessing aversive inner tension. Ratings are made on a time-oriented scale ranging from 0% (never) to 100% (constantly). We measured the psychometric qualities of the DSS in a total of 294 patients and healthy controls. Internal consistency of the DSS was high (Cronbachs α = .92; Gutmanns split-half r = .92). We found good support for convergent, discriminant, and differential validity. There was clear evidence for the DSS being a sensitive instrument for the assessment of changing symptomatology. Assessment of dissociation and other psychopathological features over the same period of time are now possible.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

CBASP ist eine Methode der Verhaltenstherapie, die spezifisch fur die Behandlung von erwachsenen Patienten mit einer chronischen depressiven Storung entwickelt wurde. McCullough, der Urheber der Methode, hat uber Jahrzehnte (Vorarbeiten gehen in die 70er-Jahre zuruck) dieses Behandlungsprogramm entwickelt und als Therapiemanual publiziert (McCullough, 2006).

Dialektisch Behaviorale Therapie – Weiterentwicklungen und empirische Evidenz

OBJECTIVE Dialectical Behavior Therapy has been initially designed and evaluated as an outpatient-treatment program for chronic suicidal female patients. Within the last years, several adaptations of DBT for specific comorbidities, other settings or other disorders related to emotion dysregulation have been developed. This report reviews conceptual aspects and the scientific evidence of initially designed Dialectical Behavior Therapy and the adaptations. METHODS Systematic literature search and systematic review. RESULTS Recently, two meta-analyses which are based on randomized controlled trials conclude robust and stabile effects of DBT Evidence from further RCTs and other studies show promise for the properties of many DBT adaptations. CONCLUSION The current review of the literature suggests a good effectiveness of DBT, especially on complex disorders with deficits in the field of emotion regulation.

Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up

Borderline Personality Disorder (BPD) is a severe, challenging to treat mental disorder. Schema therapy (ST) as an individual therapy has been proven to be an effective psychological treatment for BPD. A group format of ST (GST) has been developed and evaluated in a randomized controlled trial in the United States and piloted in The Netherlands. These results suggest that GST speeds up and amplifies treatment effects of ST and might reduce delivery costs. However, feasibility in the German health care system and with BPD patients with high BPD severity and comorbidity, and frequent hospitalization, has not been tested to date. We investigated GST in 10 severely impaired, highly comorbid female patients with BPD, that needed frequent hospital admission. Patients received an outpatient ST-treatment program with weekly group and individual sessions for 1 year. Outcome measures including BPD severity, general psychopathology, psychosocial functioning, quality of life, happiness, schemas, and modes, and days of hospitalization were assessed at the start of treatment and 6, 12, and 36 months later with semi-structured interviews and self-report measures. We observed significant decreases in severity of BPD symptoms, general symptom severity, dysfunctional BPD-specific modes and schemas, and days of hospitalization. Functional modes, quality of live and happiness improved. The results of this feasibility study are promising and encourage further implementation of ST outpatient treatment programs even for patients with severe BPD and high hospitalization risk. However, small sample size and the missing of a control group do not allow the generalizability of these findings.

A randomized study of iterative hypothesis testing in undergraduate psychiatric education

Kahl KG, Alte C, Sipos V, Kordon A, Hohagen F, Schweiger U. A randomized study of iterative hypothesis testing in undergraduate psychiatric education.

Traumatisierung und Depression

Traumatisierung oder eine Vorgeschichte von belastenden Erfahrungen in der Kindheit finden sich bei bis zu 60 % der Patienten mit einer depressiven Störung. Vermeidungsverhalten und fehlende Emotionsregulation beeinflussen dabei die interpersonellen Beziehungen der Patienten. Eine (traumabezogene) Verhaltenstherapie kann hier mit spezifischen Interventionen helfen – insbesondere mit Techniken des Fertigkeitentrainings.

Patientinnen mit Borderline-Persönlichkeitsstörung und Bulimia nervosa

Sowohl bei der Borderline-Personlichkeitsstorung als auch bei den Essstorungen gibt es vielfaltige Anhaltspunkte dafur, dass Storungen der Emotionsregulation bestehen. Im folgenden Artikel wird diese Annahme genau ausformuliert, durch ein Fallbeispiel erlautert und dargestellt, wie sich hieraus ein in sich konsistentes therapeutisches Vorgehen ableiten lasst.

Konzepte und Techniken

Zentrale Konzepte der dritten Welle der Verhaltenstherapie wie Fertigkeitendefizite, Metakognition und kognitive Fusion sind mittlerweile gut in der psychologischen Grundlagenforschung verankert. Allerdings wird häufig die Befürchtung geäußert, dass die dritte Welle bewährte, wissenschaftlich gut fundierte Behandlungstechniken über Bord wirft und durch neue, schlechter getestete, ersetzt.