Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T14:59:51.178Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of Core Affect in the Differential Efficacy of a Personality Disorder Intervention Program

Published online by Cambridge University Press:  06 February 2017

Juan M. Ramos ,
Juan M. Sendra ,
Aintzane Sánchez  and
Ana Mena
Juan M. Ramos*
Affiliation:
Hospital Dr. R. Lafora (Spain)
Juan M. Sendra
Affiliation:
Hospital Dr. R. Lafora (Spain)
Aintzane Sánchez
Affiliation:
Hospital Dr. R. Lafora (Spain)
Ana Mena
Affiliation:
Hospital Dr. R. Lafora (Spain)
*
*Correspondence concerning this article should be addressed to Juan M. Ramos. Hospital Dr. R. Lafora. Ctra. Colmenar Viejo, Km. 13, 800. 28049. Madrid (Spain). E-mail: jmramos@cop.es
Get access Rights & Permissions [Opens in a new window]

Abstract

The usual emotional experience of the person (affective style) is an influential factor in therapeutic assimilation. Based on a dynamic model of affect shaped dimensionally by the valence and arousal axes (core affect) that fluctuate over time according to the specific context of the individual, its relationship with different variables was investigated and the changes after a 6-month intervention in a specialized hospital unit (N = 103) were observed. The orthogonal structure of core-affect was confirmed. Emotional valence appeared to be positively related to social skills (r = .375; p < .01) and self-esteem (r = .491; p < .01) and negatively to depressive symptoms (r = –.631; p < .01), general disturbance (r = –.395; p < .01) and suicidality (r = –.490; p < .01). Emotional arousal is associated with impulsivity (r = .345; p < .01). The group of patients with an affective style characterized by negative valence and low arousal core-affect gained less therapeutic benefit compared to those with positive valence core-affect (p < .05). Throughout the treatment, valence became more positive (d = .26; IC 95%: 1.9 – 7.2; p = .001), arousal increased (d = .23; IC 95%: 0.2 – 1.7; p = .015) and variability decreased (d = –.44; IC 95%: (–2.9) – (–1.1); p = .001). Changes in the core-affect are related to therapeutic improvement. Adjusting expectations of change can reduce therapeutic frustration, which is as common as it is harmful in the treatment of severe personality disorders.

Keywords

emotionnegative affectpersonality disordertherapy
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 20 , 2017 , E5
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baños, R. M., & Guillén, V. (2000). Psychometric characteristics in normal and social phobic samples for a Spanish version of the Rosenberg Self-Esteem Scale. Psychological Reports, 87, 269–274.CrossRefGoogle ScholarPubMed
Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for BPD: Mentalization-based treatment versus TAU. American Journal of Psychiatry, 165, 631–638. https://doi.org/10.1176/appi.ajp.2007.07040636 Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Nueva York, NY: Guildford.Google Scholar
Boisvert, C. M., & Faust, D. (2002). Iatrogenic symptoms in psychotherapy. A theoretical exploration of the potential impact of labels, language and belief systems. American Journal of Psychotherapy, 56, 244–259.Google Scholar
Bornas, X., Noguera, M., Pincus, D., & Buela, G. (2014). Inercia emocional: La clave para comprender el proceso y los resultados de la psicoterapia [Emotional inertia: A key to understanding psychotherapy process and outcome]. International Journal of Clinical and Health Psychology, 14, 232–239.CrossRefGoogle Scholar
Carpenter, R. W., & Trull, T. J. (2013). Components of emotion dysregulation in borderline personality disorder: A review. Current Psychiatry Reports, 15, 335. https://doi.org/10.1007/s11920-012-0335-2 Google Scholar
Clarkin, J. F., & Levy, K. N. (2006). Psychotherapy for patients with borderline personality disorder: Focusing on the mechanisms of change. Journal of Clinical Psychology, 62, 405–410. https://doi.org/10.1002/jclp.20238 Google Scholar
Crawford, J. R., & Henry, J. D. (2004). The positive and negative affect schedule (PANAS): Construct validity, measurement properties and normative data in a large non-clinical simple. British Journal of Clinical Psychology, 43, 245–265. https://doi.org/10.1348/0144665031752934 CrossRefGoogle Scholar
Davidson, K. M., Tyrer, P., Norrie, J., Palmer, S. J., & Tyrer, H. (2010). Cognitive therapy v. usual treatment for BPD: Prospective 6-year follow up. British Journal of Psychiatry, 197, 456–462.CrossRefGoogle Scholar
Derogatis, L. R. (1992). The SCL-90-R. Baltimore, MD: Clinical Psychometric Research.Google Scholar
Ditzfeld, C. P., & Showers, C. J. (2014). Self-structure and emotional experience. Cognition and Emotion, 28, 596–621. https://doi.org/10.1080/02699931.2013.845083 CrossRefGoogle ScholarPubMed
Ebner-Priemer, U. W., Houben, M., Santangelo, P., Kleindienst, N., Tuerlinckx, F., Oravecz, Z., … Kuppens, P. (2015). Unraveling affective dysregulation in borderline personality disorder: A theoretical model and empirical evidence. Journal of Abnormal Psychology, 124, 186–198. https://doi.org/10.1037/abn0000021 Google Scholar
Ebner-Priemer, U. W., & Trull, T. (2011). Measuring temporal (in)stability and variability. In Mehl, M. & Connor, T. (Eds.), Handbook of research methods for studying daily life (pp. 423–439). New York, NY: Guilford.Google Scholar
Eid, M., & Diener, E. (1999). Intraindividual variability in affect: Reliability, validity, and personality correlates. Journal of Personality and Social Psychology, 76, 662–676. https://doi.org/10.1037/0022-3514.76.4.662 CrossRefGoogle Scholar
Gismero, E. (2000). Escala de habilidades sociales [Social skills scale]. Madrid, Spain: TEA ediciones.Google Scholar
González de Rivera, J. L. (2002). Cuestionario de 90 síntomas (versión española del SCL-90-R) [Symptom checklist (Spanish version of the SCL-90-R)]. Madrid, Spain: TEA.Google Scholar
Greenberg, L. S. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Gunderson, J. G., Stout, R. L., McGlashan, T. H., Shea, M. T., Morey, L. C., Grilo, C. M., … Skodol, A. E. (2011). Ten-year course of borderline personality disorder psychopathology and function from the collaborative longitudinal personality disorders study. Archives of General Psychiatry, 68, 827–837. https://doi.org/10.1001/archgenpsychiatry.2011.37 Google Scholar
Haigh, R., & den Hartog, H. (2012). Contemporary therapeutic communities: Complex treatment for complex needs. In Sarkar, J. & Adshead, G. (Eds.), Clinical topics in personality disorders (pp. 307–320). London, UK: Royal College of Psychiatrists.Google Scholar
Isaacowitz, D. M., & Blanchard-Fields, F. (2012). Linking process and outcome in the study of emotion and aging. Perspectives of Psychological Science, 7, 3–17. https://doi.org/10.1177/1745691611424750 Google Scholar
Jiménez-García, G. I., & Miguel-Tobal, J. J. (2003). El Cuestionario Tridimensional para la Depresión (CTD): Un nuevo instrumento para medir la tristeza/depresión [The Three-dimensional Questionnaire for Depression (CTD): A new instrument to measure sadness/depression]. Ansiedad y Estrés, 9, 17–34.Google Scholar
Joiner, T. E. Jr, Sandín, B., Chorot, P., Lostao, L., & Marquina, G. (1997). Development and factor analytic validation of the SPANAS among women in Spain: (More) cross-cultural convergence in the structure of mood. Journal of Personality Assessment, 68, 600–615. https://doi.org/10.1207/s15327752jpa6803_8 CrossRefGoogle ScholarPubMed
Kuppens, P., Champagne, D., & Tuerlinckx, F. (2012). The dynamic interplay between appraisal and core affect in daily life. Frontiers in Psychology, 3, 380. https://doi.org/10.3389/fpsyg.2012.00380 Google Scholar
Kuppens, P., Oravecz, Z., & Tuerlinckx, F. (2010). Feelings change: Accounting for individual differences in the temporal dynamics of affect. Journal of Personality and Social Psychology, 99, 1042–1060. https://doi.org/10.1037/a0020962 Google Scholar
Kuppens, P., Van Mechelen, I., Nezlek, J. B., Dossche, D., & Timmermans, T. (2007). Individual differences in core affect variability and their relationship to personality and adjustment. Emotion, 7, 262–274. https://doi.org/10.1037/1528-3542.7.2.262 Google Scholar
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: The Guildford Press.Google Scholar
López-Gómez, I., Hervás, G., & Vázquez, C. (2016). Adaptación de las “Escalas de afecto positivo y negativo” (PANAS) en una muestra general española [An adaptation of the Positive and Negative Affect Schedules (PANAS) in a Spanish general sample]. Behavioral Psychology/Psicología Conductual, 23, 529–548.Google Scholar
Martín-Albo, J., Núñez, J. L., Navarro, J. G., & Grijalvo, F. (2007). The Rosenberg Self-Esteem Scale: Translation and validation in university students. The Spanish Journal of Psychology, 10, 458–467. https://doi.org/10.1017/s1138741600006727 CrossRefGoogle ScholarPubMed
McMain, S. F., Guimond, T., Streiner, D. L., Cardish, R. J., & Links, P. S. (2012). Dialectical behavior therapy compared with general psychiatric management for BPD: Clinical outcomes and functioning over a 2-year follow-up. The American Journal of Psychiatry, 169, 650–661. https://doi.org/10.1176/appi.ajp.2012.11091416 CrossRefGoogle Scholar
Miller, W. R. (2004). The phenomenon of quantum change. Journal of Clinical Psychology, 60, 453–460. https://doi.org/10.1002/jclp.20000 Google Scholar
Millon, T. (1999). Inventario Clínico Multiaxial de Millon-II (MCMI-II) [Millon Clinical Multiaxial Inventory-II]. Madrid, Spain: TEA.Google Scholar
Ogden, J. (2009). A psychosocial model of behaviour change and a role for life events. The European Health Psychologist, 11, 30–32.Google Scholar
Oquendo, M. A., Baca-Garcia, E., Graver, R., Morales, M., Montalban, V., & Mann, J. J. (2001). Spanish adaption of the Barratt impulsiveness scale (BIS). European Journal of Psychiatry, 15, 147–155.Google Scholar
Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19, 276–288. https://doi.org/10.1037/h0088437 Google Scholar
Ramos, J. M., Sendra, J. M., Sánchez, A., & Mena, A. (2015). Perturbación sintomática general y afectiva en el trastorno de personalidad: Influencia de la severidad frente al tipo de trastorno [General and affective symptomatic disturbance in personality disorder: Influence of severity versus type of disorder]. Behavioral Psychology/Psicología Conductual, 23, 65–83.Google Scholar
Rodríguez-Morejón, A. (2016). El cliente en psicoterapia: Contribución al resultado terapéutico [Clients in psychotherapy: Contribution to therapeutic outcome]. Anales de Psicología, 32(1), 1–8.CrossRefGoogle Scholar
Rosenberg, M. (1989). Society and the adolescent self-image. (Rev. Ed.). Middletown, CT: Wesleyan University Press.Google Scholar
Rusting, C. L., & Larsen, R. J. (1997). Extraversion, neuroticism, and susceptibility to positive and negative affect: A test of two theoretical models. Personality and Individual Differences, 22, 607–612. https://doi.org/10.1016/s0191-8869(96)00246-2 Google Scholar
Santangelo, P. S., Limberger, M. F., Stiglmayr, C., Houben, M., Coosemans, J., Verleysen, G., … Ebner-Priemer, U. W. (2016). Analyzing subcomponents of affective dysregulation in borderline personality disorder in comparison to other clinical groups using multiple e-diary datasets. Borderline Personality Disorder and Emotion Dysregulation, 3, 5. https://doi.org/10.1186/s40479-016-0039-z Google Scholar
Santangelo, P., Reinhard, I., Mussgay, L., Steil, R., Sawitzki, G., Klein, C., … Ebner-Priemer, U. W. (2014). Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. Journal of Abnormal Psychology, 123, 258–272. https://doi.org/10.1037/a0035619 CrossRefGoogle ScholarPubMed
Sanz, J., & Vázquez, C. (1998). Fiabilidad, validez y datos normativos del Inventario para la Depresión de Beck [Reliability, validity, and normative data of the Beck Depression Inventory]. Psicothema, 10, 303–318.Google Scholar
Slade, M., Powell, R., Rosen, A., & Strathdee, G. (2000). Threshold Assessment Grid (TAG): The development of a valid and brief scale to assess the severity of mental illness. Social Psychiatry and Psychiatric Epidemiology, 35, 78–85.Google Scholar
Stanford, M. S., Mathias, C. W., Dougherty, D. M., Lake, S. L., Anderson, N. E., & Patton, J. H. (2009). Fifty years of the Barratt Impulsiveness Scale: An update and review. Personality and Individual Differences, 47, 385–395. https://doi.org/10.1016/j.paid.2009.04.008 Google Scholar
Storbeck, J., & Clore, G. L. (2008). Affective arousal as information: How affective arousal influences judgments, learning and memory. Social and Personality Psychology Compass, 2, 1824–1843. https://doi.org/10.1111/j.1751-9004.2008.00138.x Google Scholar
Trull, T. J., Lane, S. P., Koval, P., & Ebner-Priemer, U. W. (2015). Affective dynamics in psychopathology. Emotion Review, 7, 355–361. https://doi.org/10.1177/1754073915590617 Google Scholar
Vázquez, J., Jiménez, R., & Vázquez, R. (2004). Escala de Autoestima de Rosenberg: Fiabilidad y validez en población clínica española [Rosenberg Self-esteem Scale. Reliability and validity in Spanish clinical population]. Apuntes de Psicología, 22, 247–255.Google Scholar
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS Scale. Journal of Personality and Social Psychology, 54, 1063–1070. https://doi.org/10.1037//0022-3514.54.6.1063 Google Scholar
Wright, A. G. C., & Simms, L. J. (2016). Stability and fluctuation of personality disorder features in daily life. Journal of Abnormal Psychology, 125, 641–656. https://doi.org/10.1037/abn0000169 Google Scholar
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2012). Attaintment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: A 16-year prospective follow-up study. American Journal of Psychiatry, 169, 476–483. https://doi.org/10.1176/appi.ajp.2011.11101550 Google Scholar