Borderline Personality Disorder (BPD) is a complex mental health condition. Wise Moments is a four-session Acceptance and Commitment Therapy (ACT)-themed intervention for the preliminary treatment of BPD. It focuses on the ACT concept of the ‘self-as-context’ (the ‘observing self’), encouraging the person diagnosed with BPD to notice and observe their internal mental states without judgement. This study assessed the acceptability and efficacy of an ultra-brief, individual intervention based on ACT principles, designed for clients experiencing symptoms of BPD.
Method
Self-administered paper-based questionnaires were used to assess BPD symptom severity, psychological flexibility, mindfulness, self-compassion, and psychological wellbeing. Outcomes were analysed using a within subjects design, with clients assessed at admission and discharge.
Results
Fifty-one participants completed Wise Moments. The majority were female (76%) with a mean age of 35.25 years (range 18-63 years). Statistically significant improvements on all clinical outcomes were evident following completion of the Wise Moments program.
Conclusions
The results suggest that placing an early emphasis on the self-as-context within an ultra-brief intervention program has important clinical utility and supports psychological change.
StefanatouPXenakiLAKonstantakopoulosG, et al.Psychopathological determinants of quality of life in people with borderline personality disorder. J Clin Med2022; 12(1): 30–46. https://doi.org/10.3390/jcm12010030
ZanariniMCAthanasiadiATemesCM, et al.Symptomatic disorders in adults and adolescents with borderline personality disorder. J Pers Disord2021; 35(Supplement B): 48–55. https://doi.org/10.1521/pedi_2021_35_502
4.
HayesSCLuomaJBBondFW, et al.Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther2006; 44(1): 1–25. https://doi.org/10.1016/j.brat.2005.06.006
5.
De MeulemeesterCLowyckBLuytenP. The role of impairments in self–other distinction in borderline personality disorder: a narrative review of recent evidence. Neurosci Biobehav Rev2021; 127(Aug 2021): 242–254. https://doi.org/10.1016/j.neubiorev.2021.04.022
6.
HayesSCBarnes-HolmesDRocheB (eds). Relational frame theory: A post-Skinnerian account of human language and cognition. Springer US, 2002. https://doi.org/10.1007/b108413
7.
HayesSCStrosahlKWilsonKG. Acceptance and commitment therapy: an experiential approach to behavior change. Guilford Press, 1999.
8.
DixonMRHayesSCBelisleJ (eds). Acceptance and commitment therapy for behavior analysts: a practice guide from theory to treatment. Routledge, 2023. https://doi.org/10.4324/9781003250371
9.
HayesSCStrosahlKWilsonKG. Acceptance and commitment therapy: the process and practice of mindful change. 2nd ed.Guilford Press, 2012.
10.
StrosahlKRobinsonPJGustavssonT. Inside this moment: a clinician’s guide to promoting radical change using acceptance and commitment therapy. New Harbinger Publications, 2015.
11.
MortonJSnowdonSGopoldM, et al.Acceptance and commitment therapy group treatment for symptoms of borderline personality disorder: a public sector pilot study. Cognitive and Behavioural Practice2012; 19(4): 527–544. https://doi.org/10.1016/j.cbpra.2012.03.005
12.
GratzKLGundersonJG. Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behav Ther2006; 37(1): 25–35. https://doi.org/10.1016/j.beth.2005.03.002
13.
SemerariAColleLPellecchiaG, et al.Metacognitive dysfunctions in personality disorders: correlations with disorder severity and personality styles. J Pers Disord2014; 28(6): 751–766. https://doi.org/10.1521/pedi_2014_28_137
14.
SemerariA. The impact of metacognitive dysfunctions in borderline personality disorder on the therapeutic relationship and intervention technique. In: DimaggioGLysakerPH (eds). Metacognition and severe adult mental disorders. 1st ed.Routledge, 2010, pp. 269–284.
15.
DimaggioGLysakerPH (eds). Metacognition and severe adult mental disorders: From research to treatment. 1st ed.Routledge, 2010. DOI: 10.4324/9780203855782.
16.
SemerariACucchiMDimaggioG, et al.The development of the metacognition assessment interview: instrument description, factor structure and reliability in a non-clinical sample. Psychiatry Res2012; 200(2-3): 890–895. https://doi.org/10.1016/j.psychres.2012.07.015
17.
PolkKLSchoendorffBWilsonKG. The ACT matrix: a new approach to building psychological flexibility across settings and populations. 1st ed.Context Press, 2014.
18.
FirstMBGibbonMSpitzerRL, et al.Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). American Psychiatric Press Inc., 1997.
19.
PfohlBBlumNSt JohnD, et al.Reliability and validity of the Borderline Evaluation of Severity over Time (BEST): a self-rated scale to measure severity and change in persons with borderline personality disorder. J Pers Disord2009; 23(3): 281–293. https://doi.org/10.1521/pedi.2009.23.3.281
20.
BondFWHayesSCBaerRA, et al.Preliminary psychometric properties of the acceptance and action Questionnaire–II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther2011; 42(4): 676–688. https://doi.org/10.1016/j.beth.2011.03.007
McAndrewsZRichardsonJStopaL. Psychometric properties of acceptance measures: a systematic review. J Context Behav Sci2019; 12: 261–277. https://doi.org/10.1016/j.jcbs.2018.08.006
23.
Sung-YoulC. Study on validity and reliability of five facet mindfulness questionnaire (FFMQ) for measuring mindfulness meditation program before and after. J Orient Neuropsychiatry2015; 26(2): 181–190. https://doi.org/10.7231/jon.2015.26.2.181
CohenJKazdinAE. A power primer. In: Methodological Issues and Strategies in Clinical Research. 4th ed.American Psychological Association, 2016, pp. 279–284. https://doi.org/10.1037/14805-018
27.
BenjaminiYHochbergY. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc B1995; 57(1): 289–300. https://doi.org/10.1111/j.2517-6161.1995.tb02031.x
28.
CarcioneANicolòGPedoneR, et al.Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Res2011; 190(1): 60–71. https://doi.org/10.1016/j.psychres.2010.12.032
