Mindfulness

, Volume 7, Issue 3, pp 584–595 | Cite as

Impact of Mindfulness Training on Borderline Personality Disorder: A Randomized Trial

  • Matilde Elices
  • Juan C. Pascual
  • Maria J. Portella
  • Albert Feliu-Soler
  • Ana Martín-Blanco
  • Cristina Carmona
  • Joaquim Soler
ORIGINAL PAPER

Abstract

Recent research suggests that deficits in the ability to be mindful may be related to core aspects of borderline personality disorder (BPD). Mindfulness plays a central role in BPD treatment, and evidence also indicates that mindfulness is the most commonly practiced of the skills taught in dialectical behavior therapy (DBT). The present study investigated whether a 10-week mindfulness training program would improve BPD symptoms and mindfulness-related capacities in a sample of individuals diagnosed with BPD. A total of 64 participants (mean age = 31.64, SD = 6.9; 86 % female) were randomized to 10 weeks of mindfulness (n = 32) or interpersonal effectiveness skills training (control group; n = 32). BPD symptoms and mindfulness capacities were measured at pre- and post-intervention. Compared to the control group, participants assigned to mindfulness experienced a significantly greater reduction and increase, respectively, in BPD symptoms and decentering capacity. Treatment response rates (in reference to BPD symptoms) were higher for the mindfulness group (40 vs. 13 %). Interpersonal effectiveness alone did not result in improvements on any outcome measures. These findings suggest that mindfulness training may be a useful approach to decreasing BPD symptoms while simultaneously improving mindfulness capacities.

Keywords

Borderline personality disorder Mindfulness Meditation Decentering 

References

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
  2. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. doi:10.1177/1073191105283504.CrossRefPubMedGoogle Scholar
  3. Barrachina, J., Soler, J., Campins, M. J., Tejero, A., Pascual, J. C., Alvarez, E., & Pérez Sola, V. (2004). Validation of a Spanish version of the Diagnostic Interview for Bordelines-Revised (DIB-R). Actas Españolas de Psiquiatría, 32(5), 293–8.PubMedGoogle Scholar
  4. Bender, D. S., Dolan, R., Skodol, A. E., Sanislow, C. A., Dyck, I. R., McGlashan, T. H., & Gunderson, J. G. (2001). Treatment utilization by patients with personality disorders. American Journal of Psychiatry, 158(2), 295–302. doi:10.1176/appi.ajp.158.2.295.CrossRefPubMedGoogle Scholar
  5. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., & Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. doi:10.1093/clipsy/bph077.Google Scholar
  6. Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R.-D., Domsalla, M., Chapman, A. L., & Wolf, M. (2008). The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties. Psychopathology, 42(1), 32–39. doi:10.1159/000173701.CrossRefPubMedGoogle Scholar
  7. Cebolla, A., Garcia Palacios, A., Soler, J., Guillén, V., Baños, R., & Botella, C. (2012). Psychometric properties of the Spanish validation of the Five Facets of Mindfulness Questionnaire ( FFMQ ). The European Journal of Psychiatry, 26(2), 118–126. doi:10.4321/S0213-61632012000200005.CrossRefGoogle Scholar
  8. Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosomatic Medicine, 69(6), 560–5. doi:10.1097/PSY.0b013e3180f6171f.CrossRefPubMedGoogle Scholar
  9. Dimidjian, S., & Linehan, M. M. (2003). Defining an agenda for future research on the clinical application of mindfulness practice. Clinical Psychology: Science and Practice, 10, 166–171. doi:10.1093/clipsy/bpg019.Google Scholar
  10. Feliu-Soler, A., Pascual, J. C., Borràs, X., Portella, M. J., Martín-Blanco, A., Armario, A., & Soler, J. (2014). Effects of dialectical behaviour therapy-mindfulness training on emotional reactivity in borderline personality disorder: preliminary results. Clinical Psychology & Psychotherapy, 21(4), 363–370. doi:10.1002/cpp.1837.CrossRefGoogle Scholar
  11. Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007). Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–46. doi:10.1016/j.beth.2006.08.003.CrossRefPubMedGoogle Scholar
  12. Gibbon, M., & Spitzer, R. L. (1997). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders: SCID-II. Washington, DC: American Psychiatric Publishing.Google Scholar
  13. Gómez-Beneyto, M., Villar, M., Renovell, M., Pérez, M., Herández, M., & Leal, C. (1994). The diagnosis of personality disorder with a modified version of the SCID-II in a Spanish clinical sample. Journal of Personality Disorders, 8, 104–10. doi:10.1521/pedi.1994.8.2.104.CrossRefGoogle Scholar
  14. Hayes-skelton, S. A., Calloway, A., Roemer, L., & Orsillo, S. M. (2015). Decentering as a potential common mechanism across two therapies for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 83(2), 395–404. doi:10.1037/a0038305.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. doi:10.1037//0022-006X.59.1.12.CrossRefPubMedGoogle Scholar
  16. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delacorte.Google Scholar
  17. Kröger, C., Harbeck, S., Armbrust, M., & Kliem, S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51(8), 411–6. doi:10.1016/j.brat.2013.04.008.CrossRefPubMedGoogle Scholar
  18. Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377(9759), 74–84. doi:10.1016/S0140-6736(10)61422-5.CrossRefGoogle Scholar
  19. Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. Lancet, 364(9432), 453–61. doi:10.1016/S0140-6736(04)16770-6.CrossRefPubMedGoogle Scholar
  20. Lindenboim, N., Comtois, K. A., & Linehan, M. M. (2007). Skills practice in dialectical behavior therapy for suicidal women meeting criteria for borderline personality disorder. Cognitive and Behavioral Practice, 14(2), 147–156. doi:10.1016/j.cbpra.2006.10.004.CrossRefGoogle Scholar
  21. Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.Google Scholar
  22. Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. Guilford Press.Google Scholar
  23. Linehan, M. M. (2003). From chaos to freedom set. Seattle, WA: Behavioral Technology Transfer Group.Google Scholar
  24. Linehan, M. M. (2004). Wise mind: being able to drop in. Seattle, WA: Behavioral Technology Transfer Group.Google Scholar
  25. Linehan, M. M. (2014). DBT skills training manual (2nd ed.). New York, NY: Guilford Press.Google Scholar
  26. Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder a randomized clinical trial and component analysis. JAMA, 98195, 1–8. doi:10.1001/jamapsychiatry.2014.3039.Google Scholar
  27. Little, R., & Rubin, D. (1987). Statistical analysis with missing data. New York, NY: Wiley.Google Scholar
  28. Martín-Blanco, A., Soler, J., Villalta, L., Feliu-Soler, A., Elices, M., Pérez, V., & Pascual, J. C. (2014). Exploring the interaction between childhood maltreatment and temperamental traits on the severity of borderline personality disorder. Comprehensive Psychiatry, 55(2), 311–8. doi:10.1016/j.comppsych.2013.08.026.CrossRefPubMedGoogle Scholar
  29. Mott, J., Koucky, E., & Teng, E. (2015). The impact of patient preference on mental health treatment: a methodological critique and suggestions for future research. European Journal for Person Centered Healthcare, 3(1), 26–36.Google Scholar
  30. Pérez Gálvez, B., García Fernández, L., de Vicente Manzaro, M., & Olivera Valenzuela, M. (2010). Validation of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) in a Spanish sample of alcoholic patients. Adicciones, 22, 199–206.CrossRefPubMedGoogle Scholar
  31. Peters, J. R., Eisenlohr-Moul, T. A., Upton, B. T., & Baer, R. A. (2013). Nonjudgment as a moderator of the relationship between present-centered awareness and borderline features: synergistic interactions in mindfulness assessment. Personality and Individual Differences, 55(1), 24–28. doi:10.1016/j.paid.2013.01.021.CrossRefGoogle Scholar
  32. Sachse, S., Keville, S., & Feigenbaum, J. (2011). A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder. Psychology and Psychotherapy, 84(2), 184–200. doi:10.1348/147608310X516387.CrossRefPubMedGoogle Scholar
  33. Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., & Pérez, V. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47(5), 353–8. doi:10.1016/j.brat.2009.01.013.CrossRefPubMedGoogle Scholar
  34. Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martín-Blanco, A., & Pérez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150–7. doi:10.1016/j.brat.2011.12.002.CrossRefPubMedGoogle Scholar
  35. Soler, J., Vega, D., Feliu-Soler, A., Trujols, J., Soto, A., Elices, M., & Pascual, J. C. (2013). Validation of the Spanish version of the Borderline Symptom List, short form (BSL-23). BMC Psychiatry, 13, 139. doi:10.1186/1471-244X-13-139.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Soler, J., Franquesa, A., Feliu-Soler, A., Cebolla, A., Garcia-Campayo, J., Tejedor, R., & Portella, M. J. (2014). Assessing decentering: validation, psychometric properties and clinical usefulness of the Experiences Questionnaire in a Spanish sample. Behavior Therapy, 45(6), 863–871. doi:10.1016/j.beth.2014.05.004.CrossRefPubMedGoogle Scholar
  37. Stepp, S. D., Epler, A. J., Jahng, S., & Trull, T. J. (2008). The effect of dialectical behavior therapy skills use on borderline personality disorder features. Journal of Personality Disorders, 22(6), 549–63. doi:10.1521/pedi.2008.22.6.549.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Stoffers, J., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder (Review). In Cochrane Database of Systematic Reviews (Cochrane D.). Wiley. doi:10.1002/14651858.CD005652
  39. Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015). The use of dialectical behavior therapy skills training as stand-alone treatment: a systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71(1), 1–20. doi:10.1002/jclp.22114.CrossRefPubMedGoogle Scholar
  40. Wupperman, P., Neumann, C. S., & Axelrod, S. R. (2008). Do deficits in mindfulness underlie borderline personality features and core difficulties? Journal of Personality Disorders, 22(5), 466–82. doi:10.1521/pedi.2008.22.5.466.CrossRefPubMedGoogle Scholar
  41. Wupperman, P., Neumann, C. S., Whitman, J. B., & Axelrod, S. R. (2009). The role of mindfulness in borderline personality disorder features. The Journal of Nervous and Mental Disease, 197(10), 766–71. doi:10.1097/NMD.0b013e3181b97343.CrossRefPubMedGoogle Scholar
  42. Wupperman, P., Fickling, M., Klemanski, D. H., Berking, M., & Whitman, J. B. (2013). Borderline personality features and harmful dysregulated behavior: the mediational effect of mindfulness. Journal of Clinical Psychology, 69(9), 903–11. doi:10.1002/jclp.21969.CrossRefPubMedGoogle Scholar
  43. Zanarini, M., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised diagnostic interview for borderlines: discriminating BPD from other axis II disorders. Journal of Personality Disorders, 3(1), 10–18. doi:10.1521/pedi.1989.3.1.10.CrossRefGoogle Scholar
  44. Zimmerman, M., & Mattia, J. I. (2001). The psychiatric diagnostic screening questionnaire: development, reliability and validity. Comprehensive Psychiatry, 42(3), 175–89. doi:10.1053/comp.2001.23126.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Matilde Elices
    • 1
    • 2
  • Juan C. Pascual
    • 1
    • 2
  • Maria J. Portella
    • 1
  • Albert Feliu-Soler
    • 1
  • Ana Martín-Blanco
    • 1
  • Cristina Carmona
    • 1
    • 2
  • Joaquim Soler
    • 1
    • 2
  1. 1.Servei de Psiquiatria. Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau)BarcelonaSpain
  2. 2.Departament de Psiquiatria i Medicina LegalUniversitat Autònoma de BarcelonaBarcelonaSpain

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