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Cognitive Remediation Therapy for borderline personality disorder: is it a feasible and acceptable treatment? A pilot study of two single cases

Published online by Cambridge University Press:  30 July 2014

Clare Reeder*
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, UK
Peter Stevens
Affiliation:
Department of Forensic Psychology, Bracton Centre, Oxleas NHS Foundation Trust, Dartford, Kent
James Liddement
Affiliation:
Department of Forensic Psychology, Bracton Centre, Oxleas NHS Foundation Trust, Dartford, Kent
Vyv Huddy
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, UK
*
*Address for correspondence: Dr C. Reeder, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK (email: clare.reeder@kcl.ac.uk).

Abstract

Borderline personality disorder (BPD) is associated with problems in attention, memory, planning and cognitive flexibility, which may underpin aspects of behavioural dysregulation. Cognitive remediation (CR) is an individual psychological therapy which aims to improve thinking skills and thus positively impact everyday functioning. We aimed to assess the feasibility and acceptability of CR for two BPD patients who had not previously engaged with psychological therapy. Participants were assessed using neuropsychological, symptom and social functioning measures and then received up to 40 sessions of individual CR. They were re-assessed post-therapy and 3 months later, and rated their experience of CR. The participants reported increased self-esteem and improved memory. Neuropsychological tests showed executive functioning improvements post-therapy, which were partially maintained at follow-up. CR was a feasible and acceptable therapeutic approach for these two participants and may hold promise as a complementary therapeutic approach for BPD characterized by marked cognitive problems or difficulty in engaging in more emotionally focused psychotherapies.

Type
Original Research
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

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References

Bateman, AW, Fonagy, P (2006). Mentalisation-Based Treatment for Borderline Personality Disorder: A Practical Guide. Oxford: Oxford University Press.CrossRefGoogle Scholar
Beblo, T, Saavendra, AS, Mensebach, C, Lange, W, Markowitsch, H-J, Rau, R, Woermann, FG, Driessen, M (2006). Deficits in visual functions and neuropsychological inconsistency in Borderline Personality Disorder. Psychiatry Research 145, 127135.Google Scholar
Benton, AL, Hamsher, K (1976). Multilingual Aphasia Examination. Iowa City, IA: University of Iowa.Google Scholar
Bowie, CR, Gupta, M, Holshausen, K, Jokic, R, Best, M, Milev, R (2013). Cognitive remediation for treatment-resistant depression: effects on cognition and functioning and the role of online homework. Journal of Nervous and Mental Disease 201, 680685.Google Scholar
Brewin, CR, Mersaditabari, N (2013). Experimentally-induced dissociation impairs visual memory. Consciousness and Cognition 22, 11891194.CrossRefGoogle ScholarPubMed
Broadbent, DE, Cooper, PF, Fitzgerald, P, Parkes, R (1982). Cognitive Failures Questionnaire and its correlates. British Journal of Psychology 21, 116.Google Scholar
Burgess, PW, Shallice, T (1997). The Hayling and Brixton Tests. Bury St. Edmunds, UK: Thames Valley Test Company/Pearson Assessment.Google Scholar
Coid, J, Yang, M, Tyrer, P, Roberts, A, Ullrich, S (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry 188, 423431.Google Scholar
Delahunty, A, Reeder, C, Wykes, T, Morice, R, Newton, E (2002). Revised Cognitive Remediation Therapy Manual. London: Institute of Psychiatry.Google Scholar
Dell’Osso, B, Berlin, H, Serati, M, Altamura, AC (2010). Neuropsychobiological aspects, comorbidity patterns and dimensional models in borderline personality disorder. Neuropsychobiology 61, 169179.Google Scholar
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766771.Google Scholar
Fertuck, EA, Keilp, J, Song, I, Morris, MC, Wilson, ST, Brodsky, BS, Stanley, B (2012). Higher executive control and visual memory performance predict treatment completion in borderline personality disorder. Psychotherapy and Psychosomatics 81, 3843.Google Scholar
Fertuck, EA, Lenzenweger, MF, Clarkin, JF (2005). The association between attentional and executive controls in the expression of borderline personality disorder features: a preliminary study. Psychopathology 38, 7581.Google Scholar
Fonagy, P, Target, M, Gergely, G (2000). Attachment and borderline personality disorder – a theory and some evidence. Psychiatric Clinics of North America 23, 103.Google Scholar
Fonagy, P, Target, M, Gergely, G, Allen, JG, Bateman, AW (2003). The developmental roots of borderline personality disorder in early attachment relationships: a theory and some evidence. Psychoanalytic Inquiry 23, 412–59.Google Scholar
Huband, N, McMurran, M, Evans, C, Duggan, C (2007). Social problem-solving plus psychoeducation for adults with personality disorder. British Journal of Psychiatry 190, 307313.CrossRefGoogle ScholarPubMed
Legris, J, Links, PS, van Reekum, R, Tannock, R, Toplak, M (2012).Executive function and suicidal risk in women with borderline personality disorder. Psychiatry Research 196, 101108.Google Scholar
Leichsenring, F, Leibing, E, Kruse, J, New, A, Leweke, F (2011). Borderline personality disorder. Lancet 377, 7484.CrossRefGoogle ScholarPubMed
Linehan, MM (1991). Cognitive behavioural treatment of chronically suicidal borderline patients. Archives of General Psychiatry 48, 10601064.Google Scholar
McMurran, M, Huband, N, Overton, E (2010). Noncompletion of personality disorder treatments: a systematic review of correlates, consequences, and interventions. Clinical Psychology Review 30, 277287.Google Scholar
NICE (2009). Borderline Personality Disorder: Treatment and Management. London, UK: National Institute for Health and Clinical Excellence.Google Scholar
Perez, CM, Widom, CS (1994). Childhood victimization and longterm intellectual and academic outcomes. Childhood Abuse and Neglect 18, 617633.Google Scholar
Rentrop, M, Backenstrauss, M, Jaentsch, B, Kaiser, S, Roth, A, Unger, J, Weisbrod, M, Renneberg, B (2008). Response inhibition in borderline personality disorder: performance in a Go/Nogo task. Psychopathology 41, 5057.Google Scholar
Ruocco, AC (2005). The neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Research 137, 191202.Google Scholar
Ruocco, AC, Laporte, L, Russell, J, Guttman, H, Paris, J (2012). Response inhibition deficits in unaffected first-degree relatives of patients with borderline personality disorder. Neuropsychology 26, 473482.Google Scholar
Stevenson, CS, Whitmont, S, Bornholt, L, Livesey, D, Stevenson, RJ (2002). A cognitive remediation programme for adults with attention deficit hyperactivity disorder. Australian and New Zealand Journal of Psychiatry 36, 610616.Google Scholar
Tchanturia, K, Davies, H, Campbell, I (2007). Cognitive remediation for anorexia nervosa: Preliminary findings. Annals of General Psychiatry 6, 1414.Google Scholar
Wechsler D (1997). The Wechsler Adult Intelligence Scale – Third Edition, Manual. San Antonio: The Psychological Corporation.Google Scholar
Wechsler, D (2001). Wechsler Test of Adult Reading (WTAR). San Antonio: The Psychological Corporation.Google Scholar
Wilson, B, Alderman, N, Burgess, P, Emslie, H, Evans, J (1996). Behavioural Assessment of the Dysexecutive Syndrome (BADS). Bury St Edmunds, England: Thames Valley Test Company (TVTC).Google Scholar
Wilson, B, Cockburn, J, Baddeley, A (1985). Rivermead Behavioural Memory Test. Bury St Edmunds, England: Thames Valley Test Company (TVTC).Google Scholar
Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry 168, 472485.Google Scholar
Wykes, T, Reeder, C (2005). Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. London: Brunner Routledge.Google Scholar
Wykes, T, Spaulding, WD (2011). Thinking about the future Cognitive Remediation Therapy – what works and could we do better? Schizophrenia Bulletin 37 (Suppl. 2), S80–S90.Google Scholar
Zanarini, MC (2003). Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. Journal of Personality Disorders 17, 233242.Google Scholar
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