Self-monitoring of state dissociation and inner tension in psychotherapy for borderline personality disorder.

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.