Dynamic deconstructive psychotherapy
Dynamic deconstructive psychotherapy (DDP) is a manual-based treatment for borderline personality disorder.
Goals
The goals of DDP are: (1) connecting with one's own emotional experiences in order to develop an integrated sense of self and (2) connecting with others in more authentic ways, so as to improve the quality of relationships.
Focus of treatment
The primary focus of treatment is on recent
Treatment procedure
DDP is offered on a weekly basis in 45-50 minute sessions. Between sessions, clients are encouraged to work on connecting to their emotional experiences using Daily Connection Sheets, and to attempt to develop more authentic and individuated relationships outside of treatment.
DDP is a time-limited treatment proceeding through four sequential stages [4] with the duration pre-determined to be 12 months. The expectation is not that the client will be cured within 12 months, but that the client will be sufficiently recovered to move out of intensive mental health treatment. For patients who are not ready for this step at the end of 12 months, monthly maintenance sessions or 6-month blocks of weekly booster sessions are made available.
Mechanisms of change
Neuroscience research suggests that individuals with borderline personality disorder process emotional experiences through aberrant neural pathways in the brain. They are less likely to use pathways involving higher-level cortical regions responsible for episodic memory, integration, verbalization, mood regulation, and perspective-taking. Instead, they are likely to activate more primitive neural pathways in the limbic region of the brain responsible for anxiety, fear responses, and impulsivity [5] It is also established in neuroscience research that the simple act of identifying and labeling emotions can reduce activation of the limbic system and reduce physiological arousal.[6]
By repeatedly recounting recent social interactions, identifying emotions, and putting them into perspective, DDP is hypothesized to activate higher-level cortical pathways, thereby strengthening them and remediating deficits in how emotions are processed in the brain. The analogy used is to physical therapy following stroke; physical therapy repeatedly activates motor neuron pathways in the brain, thereby strengthening them and restoring control over muscle functioning and voluntary movement.
Efficacy
In separate studies, DDP has been shown to improve symptoms of borderline personality disorder (BPD), depression, and dissociation, to decrease use of hospitalization, to lessen maladaptive behaviors, such as suicide attempts, self-harm, and substance misuse, and to improve functioning. In a small, randomized controlled trial of DDP for co-occurring BPD and alcohol use disorder, clients receiving DDP achieved significantly greater improvement in symptoms of BPD, depression, and social functioning than clients receiving community-based treatment of equal intensity.[7] 90% of clients who completed 12 months of DDP achieved a clinically meaningful change in symptoms of BPD. Most participants continued to improve after treatment with DDP ended, with significant improvement noted in parasuicide behavior, heavy drinking and recreational drug use.[8] A study examining mechanisms of change indicated that therapist adherence to DDP techniques strongly predicted symptom improvement, thus suggesting specific therapeutic efficacy for DDP techniques.[9][10]
A case series of clients with co-occurring BPD and dissociative identity disorder indicated that DDP was associated with marked improvement in dissociative symptoms over 12 months.[11]
An observational study comparing naturalistic outcomes of DDP and
References
- ^ Gregory, R. J., Remen, A. L. (2008). A manual-based psychodynamic therapy for treatment-resistant borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 15-27.
- ^ Gregory, R. J. (2007). Borderline attributions. American Journal of Psychotherapy, 61, 131-147.
- ^ Gregory, R. J. (2005). The deconstructive experience. American Journal of Psychotherapy, 59, 295-305.
- ^ Gregory, R. J. (2004). Thematic stages of recovery in the treatment of borderline personality disorder. American Journal of Psychotherapy, 58, 335-348.
- ^ Schmahl, C., & Bremner, J. D. (2006). Neuroimaging in borderline personality disorder. Journal of Psychiatric Research, 40, 419-427.
- ^ Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18, 421-428.
- ^ Gregory, R. J., Chlebowski, S., Kang, D., Remen, A. L., Soderberg, M. G., Stepkovitch, J., Virk, S. (2008). A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 28-41.
- ^ Gregory, R. J., Delucia-Deranja, E., & Mogle, J. A. (2010). Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: 30-month follow-up. Journal of Nervous and Mental Disease, 198, 292-298.
- ^ Goldman, G. A., Gregory, R. J. (2009) Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 46, 480-485.
- ^ Goldman, G. A., & Gregory, R. J. (2010). Relationships between techniques and outcomes for borderline personality disorder. American Journal of Psychotherapy, 64, 359-371.
- ^ Chlebowski, S., & Gregory, R. J. (2012). Three cases of dissociative identity disorder co-occurring with borderline personality disorder treated with dynamic deconstructive psychotherapy. American Journal of Psychotherapy, 66, 165-180.
- ^ Sachdeva, S., Goldman, G., Mustata, G., Deranja, E., & Gregory, R. J. (2013). Naturalistic outcomes of evidence-based therapies for borderline personality disorder at a university clinic: A quasi-randomized trial. Journal of the American Psychoanalytic Association, 61, 578-584.
Further reading
- Gregory, R.J. Remediation for Treatment-Resistant Borderline Personality Disorder: Manual of Dynamic Deconstructive Psychotherapy (http://www.upstate.edu/ddp)