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Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy.

  • Euler S Psychiatric University Hospital (UPK), University of Basel , Basel , Switzerland.
  • Stalujanis E Psychiatric University Hospital (UPK), University of Basel , Basel , Switzerland.
  • Allenbach G Psychiatric University Hospital (CHUV), University of Lausanne , Lausanne , Switzerland.
  • Kolly S Psychiatric University Hospital (CHUV), University of Lausanne , Lausanne , Switzerland.
  • de Roten Y Psychiatric University Hospital (CHUV), University of Lausanne , Lausanne , Switzerland.
  • Despland JN Psychiatric University Hospital (CHUV), University of Lausanne , Lausanne , Switzerland.
  • Kramer U Psychiatric University Hospital (CHUV), University of Lausanne , Lausanne , Switzerland.
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  • 2018-07-15
Published in:
  • Psychotherapy research : journal of the Society for Psychotherapy Research. - 2019
borderline personality disorder
defense mechanisms
dialectical behavior therapy
model integration
psychotherapy research
Adult
Borderline Personality Disorder
Defense Mechanisms
Dialectical Behavior Therapy
Female
Health Services Research
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care
English Objective: Borderline personality disorder (BPD) is characterized by immature defense mechanisms. Dialectical behavior therapy (DBT) is an effective treatment for BPD. However, understanding the underlying mechanisms of change is still limited. Using a transtheoretical framework, we investigated the effect of DBT skills training on defense mechanisms. Method: In this randomized controlled trial, 16 of 31 BPD outpatients received DBT skills training adjunctive to individual treatment as usual (TAU), while the remaining 15 received only individual TAU. Pre-post changes of defense mechanisms, assessed with the Defense Mechanism Rating Scale, were compared between treatment conditions using ANCOVAs. Partial correlations and linear regressions were conducted to explore associations between defenses and symptom outcome. Results: Overall defense function improved significantly more in the skills training condition (F(1, 28) = 4.57, p = .041). Borderline defenses decreased throughout skills training, but not throughout TAU only (F(1, 28) = 5.09, p = .032). In the skills training condition, an increase in narcissistic defenses was associated with higher symptom scores at discharge (β = 0.58, p = .02). Conclusions: Although DBT does not explicitly target defense mechanisms, skills training may have favorable effects on defense function in BPD. Our findings contribute to an integrative understanding of mechanisms of change in BPD psychotherapy.
Language
  • English
Open access status
green
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Persistent URL
https://folia.unifr.ch/global/documents/194703
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