Examining Non-PTSD Comorbid Anxiety Outcomes for DBT Outpatients with BPD Symptomology

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INTRODUCTION:

• Anxiety disorders are highly prevalent among people with symptoms of borderline personality disorder (BPD), with comorbidity rates ranging from 75% to 90%1.

• Anxiety has been found to lessen the chance of achieving remission from BPD and increase the risk of suicide and self-harm among people with BPD2.

• Although recent studies have shown promising results using DBT among comorbid PTSD and BPD patients3,4, additional research should address comorbid anxiety symptoms other than PTSD.

CURRENT STUDY:

• This study aims to clarify the relationship between borderline symptom severity and changes in anxiety symptom severity among comorbid BPD/anxiety patients.

• Outcomes of interest:

• BSL-23 (Bohus et al., 2009)

• GAD-7 (Spitzer et al., 2006).

Method:

• Participants (N=42) who had completed measures at two time points (avg. time in treatment = 7 months) and did not meet criteria for PTSD were selected from a population of adult DBT patients in an outpatient multi-sited private practice and training facility in Southern California.

Hypotheses:

• H1: There will be a significant decrease in anxiety symptoms from pre- to post- treatment for non-PTSD DBT patients.

• H2: Borderline symptom severity at intake will moderate the effectiveness of DBT in reducing anxiety scores in a non-PTSD sample, such that those with higher initial BPD

• H3: The presence of a BPD diagnosis will be associated with greater reductions in anxiety symptoms over the course of treatment.

Examining Non-PTSD Comorbid Anxiety

Results:

• H1: Supported.
There was a significant drop in anxiety pre to post for non-ptsd DBT patients. t(38)=4.360, p<.001.

• H2: Not Supported.
The severity of BSL scores did not significantly moderate the effect of DBT on anxiety.
The interaction effect was NOT significant: F Change(1,35)= 1.142, p = .293

• H3: Not Supported.
There was no interaction of BPD status with change in anxiety over the course of treatment.

Discussion:

• Findings suggests that DBT works approximately equally well in treating anxiety across different severities of borderline symptoms.

• Findings suggest that BPD and borderline symptom severity do not interfere with the efficacy of DBT in treating comorbid anxiety symptoms.

• This study is limited by a quasi-experimental design and small sample size.

• The present study adds to existing literature on the relationship between borderline symptomatology and anxiety and may offer inspiration for clinicians working with patients presenting with multiple comorbidities.

References:

 1. Harned, M.S. & Valenstein, H.R. (2013). Treatment of borderline personality disorder andco-occurring anxiety disorders.F1000 Prime Reports. 5: 15.
2. Grambal, A, Prasko, J, & Kamaradova, D. (2016). Quality of life in borderline patientscomorbid with anxiety spectrum disorders—a cross-sectional study. Patients Prefer Adherence.
3. Steil, R., Dittmann, C., Müller-Engelmann, M., Dyer, A., Maasch, A., & Priebe, K. (2018). Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexualabuse: a pilot study in an outpatient treatment setting. European Journal of Psychotraumatology. 9(1): 1423832.
4. Harned MS. (2013). Treatment of posttraumatic stress disorder with comorbid borderline personality disorder. In: McKay D, Storch E, editors. Handbook of treating variants and complications in anxiety disorders. New York, NY: Springer Press.
5. Silverman, M.H., Frankenburg, F.R., Reich, B., Fitzmaurice, G., Zanarini, M.C. (2012).The course of anxiety disorders other than PTSD in patients with borderline personality disorder and axis II comparison subjects: a 10-year follow-up study. Journal of Personality Disorders. 26(5): 804–814.
6. Yalch, M.M., Schroder, H.S., Dawood, S., Donnellan, M.B. (2017). Relative effects of maladaptive traits and anxiety mindset on borderline personality disorder symptoms.Journal of Social and Clinical Psychology.36(4):285-299.
7. Zanarini, M.C., Frankenburg, F.R., & Fitzmaurice, G.M. (2014). Severity of anxiety symptoms reported by borderline patients and axis II comparison subjects: Description and prediction over 16 years of prospective follow-up.Journal of Personality Disorders.28(6): 767–777.

Research conducted by: Sandra Chen, M.A. , Robert Montgomery, B.F.A., Marget Thomas, Psy.D., Amanda Loerinc, Ph.D., Max Stivers, M.A., Kate Cohen, B.A., and Lynn McFarr, Ph. D

CBT California / DBT California

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