Journal of affective disorders · 2025
Self-monitoring of state dissociation and inner tension in psychotherapy for borderline personality disorder.
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Macchia A, Löchner D, Montag C, Santangelo P, Mikusky D, Nickel S, Abler B
Аннотация
BACKGROUND: Monitoring symptoms is an essential and time-consuming component of Dialectical Behavior Therapy (DBT) in borderline personality disorder (BPD). Yet, there is limited understanding regarding monitoring adherence and its influence on treatment outcomes in naturalistic settings.
METHODS: Patients (N = 99) participating in an 8-week inpatient DBT program, were offered a mobile application to monitor inner tension and state dissociation on a visual analogue scale (0-10), every 2 h on their smartphones during treatment while assessing psychopathology pre and post therapy (BDI, SCL-90, BSL-23). We analyzed adherence to monitoring techniques, assessed their impact on treatment outcomes, and employed linear mixed models to uncover dynamics between state dissociation and inner tension.
RESULTS: Patients with personality disorder (N = 55) used digital monitoring at a total compliance rate of 33.5 %, which tapered off over the course of therapy. Choosing digital monitoring instead of the paper-version went along with lower drop-out rates. Baseline trait dissociation positively predicted the association of state dissociation and inner tension during psychotherapy. The total number of app ratings was associated with reduced depressive symptoms (BDI-II), but did not suggest benefits for general and borderline-specific symptoms (SCL-90; BSL-23).
CONCLUSION: Although patients that opted for digital monitoring in our sample showed a higher therapy adherence, adherence to monitoring was associated only with a reduction in depressive symptoms, but not borderline symptomatology. The link between pre-therapy trait dissociation and in-therapy state dissociation and inner tension suggests that identifying patients with high trait dissociation and targeting dissociation during high-tension states may improve clinical management of dissociation.
METHODS: Patients (N = 99) participating in an 8-week inpatient DBT program, were offered a mobile application to monitor inner tension and state dissociation on a visual analogue scale (0-10), every 2 h on their smartphones during treatment while assessing psychopathology pre and post therapy (BDI, SCL-90, BSL-23). We analyzed adherence to monitoring techniques, assessed their impact on treatment outcomes, and employed linear mixed models to uncover dynamics between state dissociation and inner tension.
RESULTS: Patients with personality disorder (N = 55) used digital monitoring at a total compliance rate of 33.5 %, which tapered off over the course of therapy. Choosing digital monitoring instead of the paper-version went along with lower drop-out rates. Baseline trait dissociation positively predicted the association of state dissociation and inner tension during psychotherapy. The total number of app ratings was associated with reduced depressive symptoms (BDI-II), but did not suggest benefits for general and borderline-specific symptoms (SCL-90; BSL-23).
CONCLUSION: Although patients that opted for digital monitoring in our sample showed a higher therapy adherence, adherence to monitoring was associated only with a reduction in depressive symptoms, but not borderline symptomatology. The link between pre-therapy trait dissociation and in-therapy state dissociation and inner tension suggests that identifying patients with high trait dissociation and targeting dissociation during high-tension states may improve clinical management of dissociation.